When to Return to Activity after Experiencing Low Back Pain

“When can I return to my normal activity after experiencing an episode of severe low back pain?” is a question I am often asked as a physical therapist.  Low back pain (LBP) can be so severe and debilitating that it can completely derailing your training and lifestyle!  It’s hard to run, exercise or even move if your back, buttocks or leg hurts.  You either won’t try or if you do, you suffer through it only to be rewarded with worsening symptoms later on.  However, in spite of what your back pain is telling you, initial activity and exercise are critical when treating LBP. 

Everyone’s experience with low back pain is different and the severity of pain can vary wildly.  For some, even walking normally can be difficult.  This is why having a guide on which exercises and movements to do and not to do is so important.  One critical indicator that you’re ready to taper back into more regular activity (as you progress your rehabilitation-based exercise) is whether or not you can walk with a normal gait.  In particular, can you walk normally with a longer stride length during your normal gait cycle?

The ability to walk normally (notice that I didn’t say without discomfort) is an important milestone as it means that the spine is being stabilized well enough from the core musculature and that the nerves in the leg are not too tight or inflamed to tolerate and accommodate for the stretch that will occur from other activities.

If you are unable to walk normally, then the emphasis should be on regaining lumbar and lower extremity range of motion in addition to performing core and lumbar stabilization exercises.  Limit your sitting, but do not try to taper back into other activities (at least not yet).

It is critical to remember that everyone’s recovery will be different.  Recovery and tapering back into your normal activities should be entirely symptom dependent.  Listen to your body on what it can handle.  The pain will tell you if you need to stop.

When to Return to Activity after Experiencing Low Back Pain:

Follow the rule of thumb for movement:  If the pain worsens by spreading peripherally down the buttock and into the leg and/or foot, then the condition is worsening.  You must stop that activity.  If the pain centralizes and returns back toward the spine (even if the pain worsens slightly), then keep moving as the condition is actually improving.

  • Don’t resume your running, jogging or other training activities until you can walk normally at a quick pace.
  • Be sure to slowly taper back into your training as your back begins to feel better.  Don’t quickly resume your prior training volume.  Instead, taper back up.
  • Prior to activity and training, perform a very thorough warm up (including press-ups, superman exercises, and bridging).  Then transition into an activity specific warm up.
  • Continue with a core and lumbar strengthening program at least until you resume your full volume of training.

Prior to returning to your full and normal training activities, insure the following:

  • Complete lumbar mobility has returned.
  • You no longer have sensations, weakness or instability within the spine.
  • If you experienced leg pain, your involved leg is as flexible as the other.  The pain is now either gone or centralized (meaning that you’re not experiencing pain in the leg).
  • Your hip mobility on both sides is equal.
  • Your involved leg is as strong as the other leg, particularly hip abduction (glutes medius) and the hip external rotators.  Test this by jumping up and down on one leg.  Do you feel strong?  Is there pain associated with this?  If the strength isn’t there or the pain remains, you are not ready to taper up to full training activities.
  • You can jog, run, sprint, and jump without pain.

With proper treatment, low back pain (LBP) should resolve in as quickly as two weeks.  Severe episodes can take 4-6 weeks or longer.  Continue with your rehabilitation protocol until you’re performing all exercises normally.

I highly recommend continuing with a lower extremity stretching protocol and lumbar and pelvis stabilization exercises as a method of prevention for future episodes of low back pain.  There are countless “core” exercises and back stretches that you can perform, but which ones are best to help you to recover faster and experience less pain?  Research is clear that performing proper core exercises and particularly, lumbar stabilization exercises are the most effective treatment modality for LBP.  If you want to learn how to self-treat your low back and learn how to effectively exercise and work the core muscles in order to prevent or treat LBP, CLICK HERE.


In my book, Treating Low Back Pain during Exercise and Athletics, you will learn how to address specific causes of LBP as well as the best practices on how to prevent and self-treat when you experience an episode of LBP.  In this step-by-step LBP rehabilitation guide (complete with photos and detailed exercise descriptions), you will discover how to implement prevention and rehabilitation strategies to eliminate pain and get back to training and exercise sooner.

Learn how to prevent, self-treat, and manage LBP so you can get back to your daily life and exercise goals more quickly without additional unnecessary and costly medical bills!


The Number One Reason Preventing You from reaching your Exercise Goals

We all know the importance of exercise, fitness, and generally staying active.  For some of us, we look to exercise and fitness as a way to have fun and stay in shape.  Others use activity to help manage stress or chronic illnesses such as diabetes, osteoporosis or heart disease.  Exercising and staying active is an important component to aging well.  It can be very disappointing when you don’t meet your training or exercise goals.  One of the most common reasons for not meeting goals is also one of the most preventable reasons:  injury!  Nothing derails a perfectly developed training plan like an injury.

The most common injury for those in the western world is low back pain (LBP).  LBP is estimated to affect nearly 80% of the U.S. population at one time or another.  And worse yet, once you have experienced an episode of LBP you have a 90% chance of having a reoccurrence.

Risk Factors for Low Back Pain (LBP):

  • Sitting too much.
  • Slouched sitting.
  • Prior episodes of LBP.
  • Smoking.
  • Poor core and back extensor muscle strength.
  • Lack of a proper warm up and a cool down.
  • High training volumes with inadequate rest (overtraining syndrome).

Some of the specific risk factors for LBP are also risk factors for other types of injury.  Lack of adequate core strength (particularly, strength in the outer core and pelvic/hip musculature) can contribute to injuries such as:

  • Iliotibial band syndrome (ITBS)
  • Hip bursitis
  • Runner’s knee (Patellar Femoral Pain Syndrome)
  • Piriformis syndrome
  • Meniscal injuries in the knee
  • Achilles tendinitis
  • Plantar fasciitis

Although this is not a complete list, it highlights many of the most common injuries affected by weakness in the core and pelvic/hip muscles.

Consider the amount of repetitive force your body must absorb even with walking (not to mention during sports or exercise).  The outer core muscles are responsible for movement of the trunk and spine as well as aiding in stability.  (Although critical for stability, the inner core muscles don’t actually produce any trunk or spine movement.)  The outer core muscles consists of the following muscles:  lumbar paraspinal muscles; the quadratus lumborm; the internal and external obliques; and the psoas major and minor (hip flexors).  Some may also include the glutes (buttocks muscles), hamstrings, and quadriceps as part of the outer core muscles.

Imbalances or a lack of strength within the core musculature often times will manifest in altered lower body mechanics and an inability for the body to properly absorb and distribute forces.  Over time and many miles, the body’s tissues eventually break down and can lead to a repetitive use injury in the lower extremity.

As a physical therapist, I always assess the core and hip musculature and look for imbalances in strength when determining the root cause of an injury.  In the majority of cases, I find that a component of hip and core muscle weakness has led to the injury.

The good news is that this is a completely preventable problem.  Most of us already know that we need to cross train and that proper core strength is important.  However, too many of us either don’t dedicate enough time to the process or we aren’t performing the correct exercises.  Performing proper core exercises and particularly, lumbar stabilization exercises are the primary treatment modality for low back pain (LBP).

Proper core and lumbar extensor strength is the key to preventing an episode of LBP and is also a critical step in avoiding other types of injuries affected by weakness in the core and pelvic/hip muscles.  The most important factor in meeting your goals is to be consistent in your training by avoiding injury!  Don’t let LBP affect your ability to stay active and keep enjoying your favorite activities!


In my book, Treating Low Back Pain during Exercise and Athletics, you will learn how to address specific causes of LBP as well as the best practices on how to prevent and self-treat when you experience an episode of LBP.  In this step-by-step LBP rehabilitation guide (complete with photos and detailed exercise descriptions), you will discover how to implement prevention and rehabilitation strategies to eliminate pain and get back to training and exercise sooner.

Learn how to prevent, self-treat, and manage LBP so you can get back to your daily life and exercise goals more quickly without additional and unnecessary costly medical bills!


The 3 Most Common Mistakes Athletes make that can cause Low Back Pain

Whether you are an athlete or weekend warrior, we all want to perform our best.  Many of us live for the weekends so we can participate in the next run, Spartan race, CrossFit Team WOD, or any number of other adventures.  However, no one is immune to one of the one of the most prevalent medical conditions treated in the United States and throughout the western world–low back pain (LBP).

If you want to train hard and compete at a high level or even just enjoy the weekend’s events, then avoiding LBP is critical.  Avoiding the following three most common mistakes can save you from costly medical visits, prescriptions, chiropractic visits, and physical therapy services.  More importantly, avoiding injury and LBP insures that you can keep training and racing to your heart’s content!

The 3 Most Common Mistakes:


Sitting too much.

Prolonged sitting (and especially, prolonged sitting on a vibrating surface) is one of the biggest risk factors for LBP.  Sitting (slouched in particular) causes excessive strain on the lumbar discs and ligaments.  It also leads to tight hamstrings and hip flexors and generally tends to inhibit proper gluteal muscle function.

Even if you are running, exercising, and training during most days of the week, we all spend too much time sitting whether it’s at our job or traveling each weekend for destination races and events.  Even worse is sitting with chronically poor posture.

  • Limit the amount of sitting that you spend at one time.  Ideally, move from your sitting position every hour to walk preferably.  If you aren’t able to walk, then try to shift your position at least once every twenty minutes.  Frequent position changes can help you to avoid LBP.  Avoid a long car trip directly before or after a long run, race or event.  For destination events, it’s best to arrive at least a day or two early and wait a day prior to returning home.
  • Sit with correct posture.  Whenever possible, make sure that your knees stay below your hip level and that you are able to maintain your natural lumbar curve.  A McKenzie Lumbar Roll is a great tool to help you maintain correct posture.

Not training the core properly or adequately.  Don’t forget the back extensors!

Proper core and lumbar extensor strength is the key to preventing an episode of LBP, which is estimated to affect nearly 80% of the U.S. population at one time or another.  In general, most of us don’t spend enough time strengthening our core muscles (particularly, the back extensors).

The core muscles are part of the body’s natural method of stabilizing the spine.  The core muscles, along with intra-abdominal pressure, help to form the round cylinder that is utilized to support the spine.  Ligaments and boney articulations are also important in spinal stabilization.  Most people don’t realize that the core actually consists of two separate groups of muscles, the inner and outer core muscles, and neither group involve the rectus femoris muscles (the six pack).

The Multifidus Muscles

  • The inner core consists of the muscles of the pelvic floor, the transversus abdominis (TVA), diaphragm, and the multifidus muscles (which span the vertebrae along the back side of the spine as shown above).  The TVA wraps all the way around the stomach and attaches to the spine.  This is what helps to form the cylinder.  When contracted (in conjunction with the pelvic floor and diaphragm), it helps to increase the intra-abdominal pressure to support the spine.
  • The other muscles that help to support the spine are known as the outer core muscles.  These muscles are responsible for movement of the trunk and spine as well as aiding in stability.  The inner core muscles do not actually produce any trunk or spine movement.  The outer core muscles consists of the following muscles:  lumbar paraspinal muscles; the quadratus lumborm; the internal and external obliques; and the psoas major and minor (hip flexors).  Some may also include the glutes (buttocks muscles), hamstrings, and quadriceps as part of the outer core muscles.

Those that work on core strength may not be performing the correct exercises.  Performing proper core exercises and particularly, lumbar stabilization exercises are the primary treatment modality for LBP.  To learn how to effectively exercise and work the core muscles in order to prevent or treat LBP, CLICK HERE.

Not performing a proper warm up. 

An adequate warm up should always be performed to help minimize the risk of injury and maximize your ability to perform at an optimal level.  A proper warm up should include:  a cardiovascular warm up; a dynamic warm up; a specific spine warm up; and when indicated, a sport specific warm up.

Cardiovascular Warm Up

To properly prepare the body for activity, the first stage of the warm up is to increase blood flow throughout the body, but in particular, to the core muscles and spine.  I recommend approximately 10 minutes as this allows for better mobility in the joints and tissues of the body.  It starts to prime the nervous system for activity.  It also promotes healing as movement is necessary to bring in the nutrients necessary to heal (if there is already damage or an injury).

The cardiovascular warm up will vary and is dependent on your activity or sport.  I will typically start by performing a light jog or possibility some jumping jacks.  Then I may progress into some more intense heart rate increasing exercises, such as  jump roping or any other form of standing movement (jumping, bounding, and burpees), in order to increase my heart rate.  The goal is to increase your heart rate and promote blood flow throughout the body.  The warm up shouldn’t be overly intense.

Dynamic Warm Up

After my initial cardiovascular warm up, I progress into my dynamic warm up series.  This will typically involve warming up the muscles and joints of the spine, pelvis, and lower legs.

The purpose of the dynamic warm up (specifically in the lower extremity) is to insure adequate mobility in the areas that will be involved in the activity.  This will almost always include the hamstrings, hips, and pelvis.  Adequate lower leg mobility is important in order to perform your specific exercise or activity.  The more motion that can occur through the pelvis and legs, the more force can then be generated and passed through the pelvis.  More mobility in the lower legs and pelvis means less need for mobility in the spine.  This means less stress during motion will be placed on the spine—therefore, decreasing your risk of injury.  You want to maximize spinal stability and encourage movement through the hips, pelvis, and upper thoracic.

Within the dynamic warm up, you would perform exercises such as:  forward and backward leg swings; side to side leg swings; squats with rotation; and press-ups.  Utilizing a foam roller as part of a warm up is acceptable.  However, I don’t advocate static stretching before activity as it has been shown to decrease force production and performance.

Spine Specific Warm Up

I am a big proponent to performing a very specific spinal muscle warm up upon completion of the cardiovascular and dynamic warm ups.  Since you may have already experienced an episode of LBP, a very specific and thorough warm up is important for prevention.  Priming the specific muscles of the core (particularly, the multifidus and lumbar extensors) is a critical step to avoiding re-injury.  The multifidus is a critical muscle in preventing LBP and must be active to properly stabilize the spine.  It helps to prevent shearing forces from affecting the spine which is critical to avoiding LBP.

Sport Specific Warm Up

This warm up will vary significantly depending on the type of endeavor you are about to participate in.  For example, a sprinter will need a very different warm up compared to an ultramarathon runner or someone performing in a CrossFit competition.  For runners, the warm up varies.  Are you racing on a flat course or are you heading out for a very hilly trail run?

Examples of running specific exercises include:  butt kickers; strides or bounding; and warm up sprints.  Even running a little on the actual terrain you will be competing on is a good idea.

It’s important to evaluate the requirements for the event and be ready to perform the actual movements required to compete at a high level.  A proper warm up allows your body to immediately perform at its peak and reduces the risk of injury.  Regardless of the sport or event, this is also the perfect time to make sure all of your equipment is appropriate for the conditions of the event.

Don’t skip the warm up regardless of your training or event time and/or location!  You may be the only one performing a thorough warm up, but it’s because you understand the importance of one in order to prevent LBP and to improve your performance.

An inadequate cool down is another common mistake.  Be sure to take the extra time to cool down and stretch.  Start with a slow jog, and then progress to walking until your heart rate returns to normal.  This is an excellent time to utilize the foam roller as well as performing static stretches and press-ups.

It’s important to identify the common mistakes that can cause LBP.  By implementing these prevention strategies, you can avoid injury and keep training.  Fitness is a lifelong pursuit.  If you are injured or just not having fun, then you will not stay engaged and motivated in the long term.  Don’t let LBP affect your ability to stay active and keep enjoying your favorite activities!


In my book, Treating Low Back Pain during Exercise and Athletics, you will learn how to address specific causes of LBP as well as the best practices on how to prevent and self-treat when you experience an episode of LBP.  In this step-by-step LBP rehabilitation guide (complete with photos and detailed exercise descriptions), you will discover how to implement prevention and rehabilitation strategies to eliminate pain and get back to training and exercise sooner.

Learn how to prevent, self-treat, and manage LBP so you can get back to your daily life and exercise goals more quickly without additional unnecessary and costly medical bills!


How to Prevent an Ankle Sprain

Ankle sprains and strains are a common everyday occurrence.  In most cases, the injury is nothing more than a nuisance that temporarily affects your training and mobility.  However, severe cases can lead to a lengthy rehabilitation and even surgery.

Once you have experienced an ankle sprain, you’re at a higher risk for repeated injury.  Even a minor sprain can derail your training or race day preparations.  In order to avoid an ankle sprain, it’s critical to adopt a prevention strategy as part of your cross training routine.  Strength, balance, and adequate foot and ankle mobility are the key components to preventing an ankle sprain/strain.  Continue Reading

Hip Flexor Pain and Pain in the Front of the Hip

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

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

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

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

I will cover each one of these in more detail.

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

Can Foam Rolling Really Help Prevent Injury?

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

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

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

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

Range of Motion

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

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

Aids in Recovery

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

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

How to choose a foam roller:

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

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

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

How to use the foam roller:

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

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

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

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

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

How to Use the Clamshell Hip Exercise to Treat Knee Pain

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

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

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

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

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

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

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

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

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


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


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

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

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

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

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