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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!

3 Strategies to Start Right Now to Improve Health Span

You have likely heard about the life span revolution in the media. Many feel we are on the cusp of significantly advancing the length a person can live.  When in fact, the actual average number of years a person is expected to live has been stable or slightly decreasing.  This is entirely due to poor nutrition, lack of physical activity, and environmental factors.  Although the promise of a long life is appealing, one must ask an important question: Is a long life really what you want if there is no quality? Increasing the number of years that you live is not as important as increasing the way you can live those added years.  Spending an extra 5 or 25 years alive, but ill, is a curse not a blessing.

Today’s pharmaceutical giants, who fund much of this research, don’t want you to feel well during this time. Their intentions are likely not altruistic.  Imagine a longer lived population that is chronically ill.  Sounds like a lucrative opportunity, doesn’t it?

Now the good news! There are very simple and scientifically proven techniques that will allow you to improve your health span AND life span.  Health span refers to the period of time during one’s life that you are generally healthy and free from disease.

Physical factors that address health span include strength, balance, flexibility, and endurance. All of these factors affect your mobility during your life.  These same factors all contribute to your body’s physical resiliency.  Maintaining your mobility is critical for all body functions and is fundamental in avoiding chronic illness.

Elderly couple walking through the park hand in hand

3 Strategies to Start Right Now to Improve Health Span:

Weight Training

Weight training (in particular, barbell training) is a critical component in physical resiliency. Lifting appropriately heavy weights is applicable for almost everyone regardless of age and/or present health status. Weight training has positive benefits on: muscle strength; bone density; cardiovascular performance; neurologic performance and adaptability; mental and cognitive function; and proper hormonal regulation.

Barbell training is the most effective method due the progressive load on the skeletal system and the muscle pull which is exerted on the bone. It fights off frailty! It increases your body’s margin for error when illness or injury occurs. With proper guidance and the right exercise prescription/dosage, nearly everyone can improve in strength and benefit from weight training. To quote Mark Rippetoe, “Stronger people are harder to kill than weak people and more useful in general.”

Resistance training (other than through barbell training) can also be beneficial. An example of resistance training would be any type of pushing or pulling exercise that exerts a force on the muscle, which causes it to work harder than it would normally.  The key to all training is that the system must be properly overloaded to produce the desired effect.  Too little and you will not receive a positive benefit.  Too much and you risk injury.  This overload principle must guide all exercise routines if there is to be actual success and benefit from the program.  Although any properly dosed/prescribed form of resistive exercise would be beneficial, the most effective exercises either activate large muscle groups and/or load the skeletal system.  Examples include squats, lunges, and dead lifts.

High Intensity Training (HIT)

High Intensity Training (HIT) or High Intensity Interval Training (HIIT) involves performing short bursts (ranging from 30-60 seconds at a time) of activity followed by a 1-2 minute recovery. The 30-60 seconds should be at a high intensity, meaning that your rate of perceived exertion (RPE) is high and you’re breathing heavy.

The research involving HIT is ever evolving. Thus far, it appears that HIT may provide superior health benefits when compared to almost any other type of exercise. It has significant positive effects on hormone regulation, particularly Human Growth Hormone (HGH). It regulates insulin sensitivity and increases cardiovascular function (VO2 Max). It not only boosts metabolism, but it leads to greater fat loss than traditional forms of exercise.

There is ongoing research on its effects on all forms of chronic disease and illness, including Alzheimer’s disease, dementia, and cardiovascular disease. Preliminary evidence shows that HIT (when performed correctly) leads to superior benefits in much shorter bouts of exercise.

Walking after Meals

Diabetes and metabolic syndrome are major contributors to cardiovascular disease and most neurologic disorders, such as dementia. Heart disease remains the number one killer in men and women today. Regulation of blood sugar and insulin levels is such a critical aspect of being healthy in today’s sedentary, high fructose corn syrup filled lifestyle. Proper blood sugar and insulin regulation should be a primary concern of anyone desiring to live a long healthy life.

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 a person can engage in.

Although there are many aspects (mental, social, financial, physical, spiritual, and emotional) to address in order to optimize your health span, it is clear that strength training, high intensity training (HIT), and walking after meals is critical in maximizing your health span and aging well.

What are some practical actions that you can take today to improve your health span? Please leave your comments below.

I would encourage you to sign up to receive each week’s blog post sent directly to your e-mail–making it even easier and more convenient! Advice will be related to physical therapy related topics; physical fitness and performance; health and nutrition; injury prevention and rehabilitation; and successful aging and elder care. I will provide useful and practical types of “how to” information, including methods to safely self-treat and manage common physical therapy related conditions. In addition, you will receive priority when submitting questions to be featured in an upcoming blog post by e-mailing contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

6 Reasons to Self-Treat and Manage Your Health

The United States spends more money by a wide margin than any other country on health care.  Our health care system is set up to keep us from dying, not thriving.  Our average life span barely makes it in the top 30 when compared to other nations.  As it stands now, the American health care system is poorly equipped to help us maximize our health span.  Health span is defined as a period of time in which a person is generally healthy and free from serious disease.

Health care costs in America continue to increase without actual positive change in our health status as consumers.  It is imperative that we take a leadership role in our own health care by continuing to be proactive.  Part of being proactive is learning how to care for and manage common non-life threatening injuries and illnesses.  The medical system is not designed to help you to maximize your health and well-being.  It is designed to prevent you from dying and to maximize profits for the corporatocracy that controls our health care system.  It is imperative that we manage our health by learning how to self-treat non-life threatening and non-emergent injuries and illnesses.

Senior woman suffering from neck pain with eyes closed in the medical office

6 Reasons Why You Should Self-Treat and Manage Your Health:

  1. Money – Health care is expensive. Many of the most common treatments and fancy diagnostic methods are not necessary. Costs are only going to rise more in the future. As this occurs, it will be even more important to be able to take care of the simple common place injuries and illnesses. It will save you a lot of time and money!
  2. Empowerment – There is nothing more important than your health. You have control of most of the aspects in your life that affect your health status. Taking care of yourself and your health needs leads to a sense of empowerment.
  3. Improved Care – If you understand how to be healthy and take care of yourself, you will be able to assist your medical practitioner in making the best decision on how to manage your care. Remember, it is your body and your health. Being your own advocate will insure that you receive quality care.
  4. Quicker Recovery Time – Often by taking out the middle man, you can help to increase the speed of recovery. You can address the condition and help your body to initiate the healing response to insure a faster recovery.
  5. Emergency Situations – You never know when an emergency, such as a motor vehicle accident or inclement weather, may occur. You may experience an injury or illness during a camping trip when resources are a far distance away. In the event of an emergency situation, you will be knowledgeable and equipped to take care of yourself and your loved ones. (If necessary, please seek appropriate medical assistance as soon as possible.)
  6. Healthy Living – Take the time to focus on your health. Often, small changes in your diet, activity level, and relationships can make a big difference. You can take control of your health and your life! For more healthy living tips, please refer to My Top 10 Anti- Aging Tips and How to Age Successfully.

Taking a passive role in your health is not a wise choice in America’s current health care environment.  Only you are responsible for your health.  My goal is to have a positive impact on the lives of others and on the health care system in general.  I desire to accomplish this by providing useful and practical types of “how to” information. With the cost of healthcare on the rise, I desire to help proactive adults of all ages to understand how to safely self-treat and manage common physical therapy related conditions in a timely manner so they can reach their optimal health.

To accomplish this goal, I need to hear from YOU!  What are your pains?  What injuries are you suffering from?  Please submit your questions to contact@thePhysicalTherapyAdvisor.com.  I look forward to answering your health related questions!  You CAN achieve optimal health!

Get started now by checking out the Resource GuideThe specific exercise section is full of rehabilitation exercises ranging from low back pain to knee pain.  These .pdf files include photos and detailed descriptions to help you get started.  This list of resources also includes books, products, resources, supplements, topical agents, videos, and web sites that I personally use and recommend to my family, friends, clients, and patients (for use in the clinical setting).

Also, 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.

7 Reasons Why the Squat is Fundamental to Life

If you were born and raised in an industrialized nation (like the U.S.A.), then squatting was probably something you did as a child.  As soon as you became school age, you rarely squatted again.  In other countries around the world, squatting is a normal part of daily life.  In countries such as India and in many Asian countries, it is common to see very aged individuals who are still perfectly capable and comfortable in a full squatting position.  When was the last time you saw a 75 year old man in a full squat?  (A full squat will vary from person to person, but typically your hips are well below your knees and your thighs are past a parallel position.)

Here are 7 reasons why we should continue squatting as a lifelong pursuit:

1. Maintain Lower Extremity Strength: The squat activates nearly all of the muscles in the lower leg. It is particularly effective at activating the muscles in the legs referred to as the posterior chain, which includes the hamstrings, the glutes (or buttock muscles), and the hip adductors (or the groin muscles). It also activates the calves, the stabilizing muscles in the ankles, the quadriceps, as well as the core (the abdominals and lumbar extensor muscles). In short, the squat works just about every muscle in the trunk down toward the legs. These muscles are critical for all functional mobility related movements, including walking; getting up from a chair or a toilet; or picking up someone or something.

2. Maintain Lower Extremity Range of Motion (ROM): Moving into a full squat position takes quite a bit of flexibility. Most children have no problem squatting. As we age, we tend to become less flexible which is primarily due to non-use. Physiologically, muscles, tendons, and ligaments lose some elasticity and can become stiff. The squat requires good hip mobility, knee mobility, lumbar and pelvic mobility as well as ankle mobility. It requires adequate muscle length and joint range of motion in all of the major joints of the lower leg and all of the major muscles of the lower limb.


3. Maintain Bone Density: Squatting activates the major muscles of the lower limb and trunk. The pull of the muscle against the bone stimulates the bone to grow and improve its density. Squatting is also a weight-bearing exercise meaning it is against gravity. If you add any type of resistance, then that load to the bone once again stimulates bone growth. Squatting is a fundamental movement to prevent osteoporosis.

4. Maintain Balance: Squatting activates the lower leg muscles. Adequate lower leg and trunk strength is a critical component to balance. It also activates the somatosensory system. This is the integration of the neurological system (including the brain and nerves throughout the body) with the musculoskeletal system. This includes all the touch and movement nerve receptors in the muscles, tendons, and joints. (Please refer to How Do I Improve Balance? (Part I) and How Do I Improve Balance? Part II.)

5. Aids in Digestion: Many people in “civilized nations” might not know this little known fact, but incidences of constipation have increased since the advent of the toilet. This is because people are no longer squatting in the woods, over a hole, or some form of plumbing. The body’s colon has three major parts: the ascending, transvers, and descending colon. When you are in a full squat, the thighs put pressure on the ascending and descending colon, which stimulates the smooth muscles to move (this is known as peristalsis). When in the full squat position, the rectum (which is a short, muscular tube which forms the lowest portion of the large intestine and connects it to the anus) is allowed to straighten and unkink. Feces collects in the rectum until pressure on the rectal walls causes nerve impulses to pass to the brain. The brain sends messages to the voluntary muscles in the anus to relax, which permits expulsion. If you are experiencing constipation, take a walk and then spend time relaxing in a full squat position.

6. Prevents Osteoarthritis: There are many potential causes, like trauma or infection, for osteoarthritis. Trauma can be from a one-time accident or due to accumulated trauma or over-use syndrome. Just as common as over-use causing osteoarthritis is under-use. A joint cannot remain healthy if it does not move through its full available range of motion (ROM) on a regular basis. If you never move into a full squat, then you likely never take your knees or hips through their full ROM. According to osteoarthritis statistics, countries in which people still rest and spend extended time in a full squat have the lowest incidences of osteoarthritis. Squatting does not cause arthritis; it actually protects the body from it.

7. Fundamental to All Mobility: Maintaining your ability to squat, and (more importantly), come up from a squat is vital. Your ability to do so is critical to your ability to function independently. In my experience of working with seniors, there are two main reasons why a person will need additional care and support: 1. The person can no longer safely get from point A to point B (this usually involves walking). 2. The person is no longer able to stand up from a sitting position. This means he/she cannot get up and down from a chair, a toilet, or even the bed. If you cannot perform these activities safely and independently, then you will need additional care. Typically, it is a major sign of failing health when an aged and infirmed person loses the ability to care for him or her due to weakness and other factors. (This statement is not directed at someone who has suffered a spinal cord injury or has some form of paralysis which affects his/her ability to utilize lower extremities.) The squat is a critical exercise to maintain mobility and function as we age.

Squatting is one of the first abilities we develop as a child, and it needs to be one of the last ones we lose as we age.  Your ability to perform a squat is fundamental to how you are able to function throughout your life.  Keep squatting!

If you have a question that you would like featured in an upcoming blog post, please email contact@thephysicaltherapyadvisor.com.

Q & A: Do I have Carpal Tunnel Syndrome?

Q.  My hand grip has been feeling weak, and I have noticed some tingling in my first two fingers.  Do I have Carpal Tunnel Syndrome?  I use my hands all day long, and I can’t miss work for surgery.  Is there anything I can do?  -Jared

A.  Thanks, Jared, for the great question!  Carpal Tunnel Syndrome (CTS) is a very common cause of hand pain and weakness.  It’s also often associated with numbness and tingling particularly in the thumb and first (index) and second (middle) finger.  It’s often accompanied with associated motor control issues within these fingers.  The symptoms tend to start gradually and typically worsen over time.  The pain can get to a point that is unbearable.  One can lose functional use of their hands because of the pain, numbness, and associated lack of motor control.

Symptoms of Carpal Tunnel Syndrome:

  • Pain in the wrist, palm of your hand, and/or fingers.
  • Numbness and tingling in the thumb and first (index) and second (middle) finger.  The median nerve is affected.  The fourth (ring) finger and pinky finger are not directly affected because it’s a different nerve (ulnar).  Along with numbness and tingling, many people will describe an electric shock type feeling in these same fingers.  Initially, the numbness and tingling is intermittent, but it can progress into a constant sensation.
  • People describe the lack of hand control and the tendency to drop objects.

Symptoms tend to worsen when gripping or performing hard manual labor, including repetitive motions with the hands that involve flexion (closing) of the hand.  Symptoms are often worse at night and may even wake you up.

Causes and Risk Factors for Carpal Tunnel Syndrome:

  • Pressure over the median nerve near the palm of the hand in the “Carpal Tunnel” which is a type of passageway from your forearm to your wrist.
  • Repetitive motion.  CTS is typically viewed as a repetitive motion or overuse injury.  Repetitive gripping and heavy use of the hands can lead to irritation of the median nerve.  This means that professions involving heavy use or repetitive use of hands (particularly, if there is vibration) are at higher risk of developing CTS.  This can range from manual laborers to pianists or typists.
  • Scar tissue build up and/or fascial restrictions in or around the carpal tunnel from repetitive use or trauma such as repeated compression.  Chronic vibration of the hands and arms is a risk factor.  Examples include heavy use of power tools (such as a jack hammer) or motocross racing.
  • A wrist fracture can narrow the tunnel space from swelling and inflammation or cause deformation of the bones in the wrist.
  • Swelling and inflammation from other pathologies such as Rheumatoid arthritis or cysts.
  • Any injury or pathology that causes deformation of the bones in the wrist that places additional pressure on the median nerve.  This would include obesity as fat deposits can reduce the space within the carpal tunnel.
  • Females are more likely than men to develop CTS.  This is likely due to anatomical variations where the carpal tunnel is typically smaller in women versus men.  This allows the area to be more easily compromised or affected from other causes.
  • Fluid retention may increase the pressure within your carpal tunnel and be irritating the median nerve.  This is common during pregnancy and menopause.  CTS associated with pregnancy will typically resolve on its own after pregnancy.
  • Muscle imbalances between wrist flexion and extension strength.
  • Mobility related issues in the wrist, shoulder, thoracic, and cervical spine.

CTS can be straightforward with a very typical mechanism of injury or can be very difficult to treat because of multiple factors leading to the syndrome.  Often it’s a multitude of risk factors that cause the symptoms in addition to anatomical variations from person to person.  Other compounding factors include:  diabetes; thyroid disease; kidney failure; other forms of inflammatory arthritis; poor posture; and cervical and thoracic derangements.

Poor wrist, shoulder, cervical, and/or thoracic mobility is often associated with CTS and other spine and/or upper extremity pain syndromes.  I find that even in the clearest cut of cases it’s always best to screen for other potential causative factors by starting with the cervical spine and working down the chain into the hand.  Whenever one part of the body doesn’t have adequate mobility, another part will do more to allow for the movement to take place.

My Top Recommendations to Alleviate Pain associated with Carpal Tunnel Syndrome:

Identify the offending movement.

If you’re experiencing CTS pain, try to identify which specific movement aggravates the symptoms.  Once you identify the movement, find ways to either avoid the motion or to change how you perform the activity as to not cause the symptoms.  This may mean adjusting your posture or body position or using an adaptive device to help your body compensate for the activity.  Eliminate as many of the noted risk factors from your daily activities as you can.

Work on your grip strength through extension movements.

Don’t just work on wrist flexion or gripping exercises.  Also work on finger and wrist extension in order to improve your grip strength.  Often in the case of CTS, there is a muscle imbalance between your ability to flex your fingers and wrist versus extending your fingers or wrist.  Work on extension biased exercises.  Your grip strength will improve more rapidly as your wrist and hand muscles find their optimal length tension relationship (which allows for maximum strength production).

For wrist extension, use an exercise band (as demonstrated below) to perform two to three sets of 20 repetitions.  Extend the wrist up, and then slowly back down toward the floor.  Be sure to move very slowly during the eccentric/muscle lengthening position (when your hand returns to the floor).

To improve finger extension strength, I often recommend using a thick rubber band as a way to improve finger extension strength (as demonstrated below).  Work on extending each finger equally when performing two sets of 10-15 repetitions multiple times per week.

If you want to be more precise and have the ability to exercise one finger at a time, try a device such as the CanDo® Digi-Extend® Hand Exerciser.  This is an excellent tool to improve finger extension strength.  It allows you to work the fingers in multiple ways including individually for rehabilitation purposes and as an important hack to improve overall grip strength (as described above).  It also allows for customization of resistance so you can track progress.


I suggest stretching the fingers and wrist multiple times a day.  Your fingers and wrist should have mobility in all directions.  Particularly focus on wrist extension (as demonstrated below).  Perform two to three sets of a 30 second stretch three to five times per day as long as you do not reproduce your CTS symptoms.

Work on your mobility.

Restrictions in mobility typically don’t just occur in the fingers and wrist, but also up the arm and into the thoracic and cervical spine.  I like to use items, such a PVC pipe, that you might already have at home.  This works great for forearm mobilization.  You could also use a golf ball.  You can use one hand to press or rub the PVC pipe over sore or tender areas.  The amount of pressure shouldn’t be painful.  Avoid pressing on especially boney areas.

Poor mobility elsewhere in the kinetic chain can and will affect hand and wrist symptoms.  Work on upper body mobility by focusing on shoulder and thoracic mobility.  You can automatically download my FREE resource for shoulder and thoracic mobility, My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain, when you subscribe to my e-mail list.

Be proactive.

Once you start to feel pain, be aggressive with your management and self-treatment.  Implement these recommended exercises, stretches, and mobilizations quickly so you can stop the pain from progressing.  It’s always easier to intervene early.  Take your rehabilitation seriously and perform the exercises diligently while you work to eliminate risk factors that may be affecting the condition.

Contact your Physical Therapist (PT).

If the pain persists, seek additional help.  Don’t let the pain linger.  The longer it’s left untreated, the more potential for harm and damage (which potentially could lead to a longer recovery).  The American Physical Therapy Association (APTA) is an excellent resource for learning more about physical therapy as well as locating a physical therapist in your area.

Thanks for the question, Jared!  Carpal Tunnel Syndrome (CTS) can be debilitating by limiting your ability to exercise, work, and perform daily tasks.  Be proactive in your care and management.  Most importantly, don’t let the pain and symptoms linger.  The longer you have the symptoms, the harder they can be to eliminate and recuperate from.

Have you ever dealt with Carpal Tunnel Syndrome (CTS) pain?  Which treatments have you found to be the most effective?  Additional discussion can help others to manage their pain.  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!

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

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 Become a Resilient Runner

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

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

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

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

How to Become a Resilient Runner

Resilient Runners Avoid Injury.

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

Resilient Runners Train More.

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

Resilient Runners Recover More Quickly.

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

Resilient Runners Save Money.

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

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

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

  • Lower Back Pain and Piriformis
  • 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.

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

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

More written content and videos are in the works, but if you sign up now you will get access to everything at one special introductory price! 

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


Why You Won’t Heal – Part 6

Risk Factors and Causative Factors are still affecting the Condition

During the recovery process, it’s important to reflect on how the injury or illness occurred.  What were the causative factors that led to the specific injury?  What choices did you make that would have caused this illness?  In order to optimize the healing response, all risk factors and causative factors must be addressed.  In the final Part 6 of the series, Why You Won’t Heal, you will learn how to discern if the risk factors and causative factors that led to the injury and/or illness are still present and affecting your current condition.

You may be getting the best quality care and treatment regime for your specific condition, but if the original causative factors are still present then your ability to recover is significantly impaired.  When possible, always address the root cause of the problem and then determine the appropriate rehabilitation program.

The ultimate goal is to eliminate the leading causative factors and then establish the proper care and treatment.  This includes addressing any potential psychological beliefs associated with the injury as well as insuring that you are consuming quality nutrients and getting enough sleep in order to recover properly.

As a physical therapist, I continue to see countless examples of individuals who may be getting the right treatment, but yet he/she still struggles to heal because the risk factors and causative factors that led to the injury and/or illness are still present and affecting his/her current condition.

The following example illustrates what happened to one of my prior physical therapy clients.

A 30 year old man presents with frequent headache pain and neck pain.  Together we work on restoring proper thoracic and cervical (neck) range of motion as well as proper strength through the cervical and thoracic spine.  He feels much better, but yet he continues to experience intermittent pain and headache symptoms.

His pain levels are worse while at work.  He takes pictures of his office, and a coworker records a short video of him working at his desk.  Upon viewing, I discover that his office set up is incorrect with the keyboard and monitor not properly positioned (poor ergonomics).  He’s working in a slouched posture which causes a forward head and rounded shoulders.

If this is his typical posture throughout a majority of his work day, is there any wonder why his headaches persist?  His posture is causing excessive strain on his neck and upper back every day while at work.

Once his work ergonomics were improved and he was more mindful about his posture, he was pain-free and headache-free.  If the underlying reason for his ongoing pain and headaches hadn’t been correctly addressed, then his recovery would have been less than optimal and his symptoms would have likely persisted or eventually worsened.

The reasons why a person may not recover are vast and complicated.  Your rehabilitation protocol will vary and is dependent on the type of injury or illness you have.  Regardless of the specific injury or illness, it’s critical that the following six categories of common reasons why a person will not fully heal and recover or take an extended time are addressed.

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.

The body’s ability to heal and recover is dependent on many things.  To maximize your ability to heal and recover from illness and recovery, it’s important to be proactive and help your body in any way possible.  Getting to the root cause by utilizing these strategies for recovery will insure that you will heal and recover and/or effectively be able to manage your injury or medical condition.

Have you experienced a prolonged recovery or rehabilitation process?  If so, can you share any strategies that helped you to handle 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!