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

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!


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.

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

The Injury Episode!

With Special Guest Dr. Ben Shatto

Marathon Training Academy

May 11, 2017

In this podcast interview with Angie Spencer (RN and Certified Running Coach) and Trevor Spencer (co-host of the Marathon Training Academy Podcast), we discuss the prevalence of running injuries, the top mistakes we see runners make, and answer injury related questions from runners.

In this episode we talk injury prevention with our friend and physical therapy doctor Ben Shatto. Plus we answer injury related questions from real everyday runners like you. Glutes, calves, hamstrings, IT Band, foot and knee pain . . . we cover it all! Listen to the podcast

Disclaimer: This blog post and podcast are not meant to replace the advice of your doctor/health care provider, or speak to the condition of one particular person but rather give general advice.

The Truth About Running Injuries

Marathon Training Academy

May 3, 2017

In this guest post for Marathon Training Academy, you will learn how to identify the risk factors and potential causes of overuse running injuries so that you can avoid training errors which can result in lost training days, missed races, and unmet goals.

Running is one of the most popular sports and hobbies in recent times.  In the U.S. alone, there are more than 500,000 annual marathon finishers and up to 40 million people who run regularly.

Of those 40 million people, more than 10 million are running at least 100 days a year!

Running can be enjoyed by almost anyone despite age.  Not only is running fun, but it has many health benefits including (although not limited to) the following:  Continue Reading

How to Avoid Overtraining Syndrome (OTS)

Marathon Training Academy

April 28, 2017

Don’t let an injury or overtraining syndrome (OTS) derail your running plans or affect your performance.  In this guest post for Marathon Training Academy, you will learn which strategies to implement as you self-treat and manage any potential injury safely and quickly.

Nothing can derail your best laid training plans and goals like an injury or suffering from Overtraining Syndrome (OTS).  OTS usually starts with muscle soreness and a feeling of fatigue.  Then it quickly progresses into a case of overtraining syndrome or injury.  Overtraining can occur when the intensity and/or volume of exercise becomes too much for the body to properly recover from.  Many common running injuries are directly associated with OTS.  It’s always best to prevent OTS rather than attempt to recover from it.  Continue Reading

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  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 and Michael Caron from
  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  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!