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.

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

http://marathontrainingacademy.com/avoid-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

http://marathontrainingacademy.com/injury-episode

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

http://marathontrainingacademy.com/truth-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

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!

How to Avoid Overtraining Syndrome (OTS)

http://marathontrainingacademy.com/overtraining-syndrome

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