Category Archives: Physical Therapy

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How to Perform a Key Lower Leg Stability Exercise

Weakness in the deep external rotation muscles and poor lower extremity single leg balance are commonly associated with many lower extremity overuse injuries. A simple and effective exercise to improve strength, balance, and general stability of the deep hip external rotator muscles is the clock exercise (also called the star drill).

The important points to remember in this exercise are to keep the stance knee unlocked (the leg you are standing on) with the patella (knee cap) slightly externally rotated (usually pointing towards the 3rd or 4th toe). The rotation must come from the hip, NOT the ankle. The stability of the hip and activation of the deep hip external rotators needs to be the primary focus.

Slowly touch the ground very gently with the opposite leg. The amount of pressure touching the ground should be so slight that if there were a package of crackers taped to the bottom of the foot the crackers would not break. Performing the drill on a balance pad will significantly increase the difficulty level of the exercise.

In the following video, I demonstrate how to use a balance pad to perform the clock exercise, a key lower leg stability exercise for treating knee pain, hip pain, and foot and ankle related issues as well as balance.

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For additional videos on my recommended exercises to increase hip strength and stability, be sure to check out:

For prevention strategies and to learn more about on how to self-treat the most common lower extremity overuse injuries, be sure to check out the Resilient Runner Program, which 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.

Have you performed the clock exercise before? If so, what was your experience like? 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. In case you haven’t already, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by liking The Physical Therapy Advisor!

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How to Perform a Key Hip Stability Exercise

Hip pain, knee pain, and even foot pain (such as plantar fasciitis or posterior tibialis syndrome) can have an associated hip external rotation weakness. An important yet often overlooked component to proper lower extremity stability is how the deep hip external rotator muscles need to work along with other hip external rotators and hip abductors, such as the gluteus medius, to insure proper lower extremity positioning when the leg is in full weight bearing. Particularly, in a single leg stance position during walking, running, skipping or landing from a jump as the leg accepts full weight bearing while the opposite leg is in swing phase.

The deep hip rotators, also known as the short external hip rotators, are a group of muscles consisting of the superior and inferior gemelli, obturator internus, quadratus femoris, and the piriformis. This group of muscles is extremely important for stability of the body, pelvis, and leg as the leg/foot initiates full ground contact.

Weakness in these muscles is often associated with many of the more common lower extremity overuse injuries:

  • Foot injuries: Plantar Fasciitis, Achilles Tendinitis, Posterior Tibialis Syndrome
  • Knee injuries: Patella Femoral Pain Syndrome (PFPS), Iliotibial Band Syndrome (ITBS)
  • Hip related issues: Piriformis Syndrome, Hip Bursitis,  Hip Impingement

A simple and effective exercise to improve strength of these muscles is the standing hip 3-way exercise. The important points to remember in this exercise are to keep the stance knee unlocked and in a “soft” stance with the patella (knee cap) slightly externally (laterally) rotated (usually pointing toward the 3rd or 4th toe). The rotation must come from the hip, NOT the ankle. The stability of the hip and activation of the deep hip external rotators should be the primary focus.

In the following video, I demonstrate how to use an exercise band to perform the standing hip 3-way exercise, a key hip stability exercise for treating hip pain, knee pain, and foot and ankle related injuries.

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For additional videos on my recommended exercises to increase hip strength and stability, be sure to check out:

For prevention strategies and to learn more about on how to self-treat the most common lower extremity overuse injuries, be sure to check out the Resilient Runner Program, which 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.

Do you suffer from hip, knee or foot pain? If so, hip external rotation weakness may be part of the reason for the ongoing pain as you overload and overuse other structures trying to gain extra lower leg support. Additional discussion can help others to manage this condition more effectively. 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. In case you haven’t already, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by liking The Physical Therapy Advisor!

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3 Easy Exercises to eliminate Wrist and Elbow Pain

Hand, wrist, and elbow pain is all too common (particularly, with computer, tablet, and phone use). Pain in any one of these locations affects all of us from time to time. The two most likely reasons for developing hand, wrist, and elbow pain are from overuse and poor posture.

Poor wrist, shoulder or thoracic mobility is also commonly related to hand, wrist and/or elbow pain. If the wrist cannot flex or extend properly, it not only causes wrist pain, but excessive stretching of the forearm muscles and strain on the elbow (possibly leading to pain). Poor shoulder or thoracic spine mobility can also cause excessive strain on the elbow, wrist and/or hand.

In this video post, I describe three easy exercises to help you quickly eliminate pain in your hand, wrist, and elbow. I demonstrate two simple stretches with an easy variation to improve their efficacy and teach you how to easily improve your hand and wrist strength using a simple rubber band.

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Posture plays a critical role in the positioning of your extremities with movement and even when sitting (including office and/or computer work). Improper posture combined with poor ergonomics is a top reason to develop not only elbow pain, but also neck, upper back, shoulder, and wrist pain. Regardless if the activity is weightlifting or typing, your posture matters!

For additional ways to easily improve your posture and reduce pain in the arm/hand as well as the neck and shoulder, be sure to subscribe to my e-mail list to gain immediate access to My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain for step-by-step exercise instructions and photos.

Hand, wrist, and/or elbow pain can be debilitating and limit your ability to exercise, work on the computer or even use your phone. Be proactive in your care and management. If the pain persists, seek additional help. Don’t let the pain linger. The longer it’s left untreated, the more potential for harm and damage which potentially could lead to a longer recovery. The American Physical Therapy Association (APTA) is an excellent resource for learning more about physical therapy as well as locating a physical therapist in your area.

Do you have any other favorite exercises or stretches to reduce hand, wrist or elbow pain? Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. In case you haven’t already, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by liking The Physical Therapy Advisor!

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How to Quickly Fix a Kink in Your Neck

Have you ever woke up from a good night of sleep with a kink in your neck? How about not being able to move your head without pain? Yeah, me, too. How about a sore neck or a stiff neck after exercising or doing an activity like painting? Yep, I have had that, too.

So often this “kinked neck” or “stiff neck” feeling is easily self-treatable. In the following video, I demonstrate a very simple and effective method to self-treat that painful stiff neck feeling that we all get from time to time.

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If you want a more detailed explanation of neck pain and ways to prevent it from occurring, be sure to read my post on neck pain, headaches, and the “core” muscles of your neck. You will discover why it’s important to insure proper cervical core strength in order to not only alleviate neck pain and headaches, but also to prevent them from reoccurring.

For additional ways to easily improve your posture and reduce pain in the neck and shoulder, be sure to subscribe to my e-mail list to gain immediate access to My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain for step-by-step exercise instructions and photos.

Also, please refer to my video, What to Do When You Can’t Look Up.

Have you ever suffered from a stiff or painful neck? Which treatments have worked the best for you? 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 contact@thePhysicalTherapyAdvisor.com. In case you haven’t already, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by liking The Physical Therapy Advisor!

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How to Improve your Recovery from Injury, Illness or Surgery

There are many reasons and factors that affect a person’s ability to heal and recover from an injury, illness or surgery. One of the most common reasons is poor nutrition. The healing tissue along with the body may not be receiving proper base components to actually heal. Poor nutrition can negatively impact how one heals from an injury or illness. Consuming the right foods can provide the proper nutrients for your body to fully heal and recover from an injury, illness or surgery. If you truly want to take all of the steps possible to improve your chance of recovery, then addressing nutritional needs and food quality is a must! Continue Reading

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The Clamshell: A “go to” Exercise for Treating Foot, Hip, and Knee Pain

Do you suffer from foot, hip or knee pain? If so, hip external rotation weakness and poor single leg balance may be part of the reason for the ongoing pain as you overload and overuse other muscle groups in order to gain extra lower leg support. Weakness in the deep external rotation muscles is commonly associated with many lower extremity overuse injuries.

Injuries commonly associated with hip weakness include:

  • Foot/ankle injuries such as plantar fasciitis, Achilles tendinitis or posterior tibialis syndrome.
  • Hip related issues including piriformis syndrome, hip bursitis, and hip impingement.
  • Knee injuries such as Patellar Femoral Pain Syndrome (PFPS) and Iliotibial Band Syndrome (ITBS).

The deep hip external rotator muscles need to work along with the hip abductors (such as the gluteus medius) to insure proper lower extremity positioning when the leg is in full weight bearing. (Particularly, in a single leg stance.) One leg bears the full weight while the opposite leg is in the swing phase while walking, running or skipping.

The deep hip rotators (also known as the short external hip rotators) are a group of muscles including:  the superior and inferior gemelli muscles; obturator internus; quadratus femoris; and the piriformis. This group of muscles is extremely important for stability of the body, pelvis, and leg as the leg/foot initiates full ground contact.

The clamshell exercise is a commonly prescribed exercise designed to target the hip abductors and hip external rotators. However, this exercise is often performed incorrectly or ineffectively. 

In the following video, I demonstrate my preferred method of performing the clamshell exercise in order to insure optimal effectiveness.

In order to engage the deep hip rotators, you should feel the muscles working deep into the buttocks and directly behind the greater trochanter (the hard bone that pokes up at the top of the hip).

This exercise should be performed very slowly. I advise a count of 5 seconds up, a 5 second hold, and then a 5 second slow return to the starting position for at least 10 repetitions.

If you aren’t feeling the deep hip rotators activate, then you may need to reposition your legs. Usually, repositioning the knees and moving them up toward your head into a more fetal position will do the trick.

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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. In case you haven’t already, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by liking The Physical Therapy Advisor!

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How to Improve Your Sleep Quality

The ability of the human body to heal and recover is nothing short of amazing. The body has an innate way of healing and thriving. Sleep is one of the most important aspects to thriving and aging well. Your body thrives on a routine, so preparing for bed shouldn’t be any different than your other daily routines.

Although I am not a sleep expert, I have regular discussions with my physical therapy clients regarding sleep quality and hygiene. Adequate sleep is one of the most important components to a person’s recovery post illness and injury in addition to thriving and aging well. Continue reading for tips on how to get a better night of rest.

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A Core Stability Exercise that Anyone Can Do

Proper core and lumbar extensor strength is the key to preventing an episode of low back pain (LBP) as well as an important component to treating LBP. Low back pain 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 properly strengthening our core muscles. In this video post, you will learn how to engage your abdominal muscles with a simple ball exercise that I recommend to all of my patients initially in my LBP rehabilitation program.

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 working 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.

In this video, I demonstrate an easy and effective way to actively engage the inner core abdominal muscles. This exercise is typically safe even early on during the rehabilitation process for low back pain. 

For more information on how to effectively exercise and work the core muscles in order to prevent or treat LBP, be sure to check out 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.

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In addition, check out this sample video, Segment 2: What are the Core Muscles?, taken from my Treating Low Back Pain (LBP) during Exercise and Athletics Video Package which you can purchase HERE.

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. In case you haven’t already, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by liking The Physical Therapy Advisor!

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Osteoarthritis vs. Rheumatoid Arthritis

What’s the Difference?

By Dr. Matthew Crooks

Arthritis is a condition involving tenderness and swelling in your joints, and it’s often coupled with inflammation as well. With over 100 different types of arthritis, the two most common forms are Osteoarthritis (OA) and Rheumatoid Arthritis (RA). Both of these involve inflammation in the joints; however, learn how these conditions differ.

Breaking Down the Differences

The main differentiator between Osteoarthritis and Rheumatoid Arthritis is that RA is an autoimmune disorder while OA is a degenerative disease. Another major difference between the two is that RA is a type of polyarticular arthritis meaning that it affects multiple joints as well as different sides of the body. Osteoarthritis affects only a few joints and just one side of the body.

Autoimmune

An autoimmune disease is one that causes your body to think there is an issue in a particular area. As a result, it attacks and damages healthy tissue. In the case of RA, it causes your body to attack the tissue surrounding the affected joints. Your immune system will produce antibodies that will attach themselves to the joints. Your body will then attack these joints which then cause inflammation, swelling, and pain in the area.

Degenerative

Being a degenerative disease, OA is one that affects you as you begin to age as well as prolonged wear and tear on your joints. Over time, the protective cartilage that pads and protects the ends of your bones begins to wear down. As this cartilage begins to wear down, the bones within the joint will start to rub together, resulting in pain and stiffness.

Osteoarthritis Symptoms:

Pain and stiffness within the joints are the most common symptoms of Osteoarthritis. These two symptoms typically appear in the morning or after a period of rest.

Some other symptoms that you will notice with OA: 

  • A limited range of motion or stiffness that tends to go away after activity.
  • Clicking or cracking sounds when bending a joint.
  • Mild swelling in the joint area.
  • Tenderness to touch.
  • Pain in the joint that gets worse with activity and at the end of the day.

The most common areas that are affected are hands, fingers, knees, hips, and spine. Over time these symptoms will increase and build up rather than show up suddenly and out of nowhere. However, if the stressors that are causing the wearing and breaking down of the joint cartilage are continued, you may notice a sudden increase in the symptoms.

Rheumatoid Arthritis Symptoms:

Like Osteoarthritis and other forms of arthritis, pain and stiffness will be associated with Rheumatoid Arthritis. Besides this, RA will bring with it: swelling; tenderness; and more than one joint that is affected or the same joint on either side of the body is affected. Fatigue and loss of appetite can also be symptoms of RA.

Other areas of the body can also be affected when dealing with RA besides your joints. The prolonged inflammation that comes with the disease can cause the following:

  • Dryness, pain, and redness in your eyes.
  • Dry mouth.
  • Gum irritation.
  • Small lumps under your skin called rheumatoid nodules.
  • Shortness of breath.
  • Anemia.

Osteoarthritis Prognosis

The prognosis for those with Osteoarthritis will vary from person to person and case to case. There are some cases where patients will not be adversely affected much at all by OA while others are severely affected. The fact that it’s a degenerative disease carries the assumption that the condition will continue to get worse over time.

While this is the case with some patients, other times the disease tends to stabilize at a certain point. While some patients will eventually need to undergo some sort of joint replacement surgery, it’s rare for the condition to progress enough for this to be the recommended course of action.

Osteoarthritis is not a condition that can be reversed. However, it is a condition that can be treated. When experiencing symptoms of OA, limiting the activity in those joints and the amount of stress you put on them will help. The most effective strategies you can take are to maintain a healthy weight and exercise regularly.

Rheumatoid Arthritis Prognosis

In the past, Rheumatoid Arthritis carried a more negative prognosis than it does today. Typically, patients can now live a productive and healthy life while continuing to go to work, school and partake in social and physical activities.

Like most conditions though, the prognosis will vary from case to case. In some patients, the symptoms will go through periods of dormancy while others will experience chronic symptoms. In some severe cases, life expectancy can decrease but this is not as common.

Common prognoses associated with RA include: persistent joint inflammation; a decline in mobility/range of motion in the affected area; and pain and stiffness that does not improve with treatment.

Like OA, it can affect other areas of the body as well, outside of the joints. Some patients will experience psoriasis; heart disease; eye inflammation; osteoporosis; anemia; respiratory complications; and depression. Patients with RA will need constant medical care and should be in contact with their primary care physician as well as a rheumatologist regularly.

Treatment

While both of these conditions are chronic and neither can be cured, both are treatable. Treatment can make living with the disease more comfortable (and in some cases, normal).

Reducing inflammation is an important part of treatment. A doctor may suggest anti-inflammatory drugs which will also alleviate the pain and stiffness in the joint. Other forms of treatment are physical therapy or injections depending on your specific area of pain.

Increasing the mobility and range of motion in the affected area will help slow down the progression of the disease. It’s important to be in contact with your doctor if you are experiencing any of these symptoms. There are always options to improve your quality of life.

For more information on RA and OA, please refer to Q and A: Exercises Beneficial to Managing Rheumatoid Arthritis and 4 Key Strategies for Preventing and Treating Osteoarthritis.

About Dr. Matthew Crooks

Dr. Matthew Crooks is a double board certified, fellowship trained interventional pain specialist. He has had the distinction of training with leading experts in pain medicine at two of the nation’s top hospitals, with extensive training in acute and chronic pain management, completing residency in Anesthesiology at Johns Hopkins Hospital. While at Johns Hopkins, he had the honor of being selected Chief Resident of the Department of Anesthesiology and Critical Care Medicine for the 2008-2009 year.

 

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Getting in Shape while Avoiding Overuse Training Syndrome (OTS)

New Year…New You! With the beginning of a new year comes the drive to want to do something different and better than the previous year. Resolutions, new changes, new outlooks, and new workout routines are on the top of many people’s resolution list for the new year.

Getting in shape is important for your physical and mental health, but as with everything, you can do too much. As we get into our new routines with fresh motivation, we push ourselves harder–we run faster, swim further, and lift more. Yet while our new workouts may seem outwardly healthy, we may actually be doing ourselves harm in the long run.

Why? For some of us, the exercise routines we have been inspired to take on have turned from ‘healthy’ to ‘unbalanced’. It may be that we progressed too fast or our volume or intensity of training is too high for our present conditioning.

More commonly, there was not enough attention put into the recovery portion of training. In other words, as we’ve pushed ourselves on the court, in the pool or on the bike, we’ve lost track of our personal limits. We’ve fallen prey to what is generally called Overuse Training Syndrome (OTS). It’s also referred to as Overtraining Syndrome.

Overuse Training Syndrome is pretty much exactly what it sounds like: it occurs when the body is pushed too far during exercise and/or training–over and above its limits for too long–thereby causing it to lose its ability to recover in a sustainable and safe way. For obvious reasons, this wreaks havoc on both your health and your training routine, not to mention to your mental endurance. The training cycle should consist of a balance of training, recovery, and then adaptation. Too much training and not enough recovery means no adaptation and in the case of OTS, a regression of health and training status.

Overtraining typically leads to worsening performance and results. Unfortunately, the most common reaction to OTS is an even greater commitment to training harder, faster, and more often. The effects typically end in disaster.

Overuse Training Syndrome (OTS) Symptoms:

  • OTS makes you tired–not in the traditional ‘good workout sense’, but fatigued in a way that throws your training and muscle wellness off balance. This type of exhaustion is often confused with a sense of demotivation or laziness, thus leading many people to push-through and push harder. Sadly, this approach does a lot more harm than good as it delays recovery for longer periods which places even more stress on your overall health, stamina, fitness, and body. This is typically due to over fatigue in either the sympathetic or parasympathetic nervous system depending on your most common form of exercise/training.
  • OTS feels a little like the flu: a dull aching in your muscles and joints, lightheadedness during exercise, slight nausea, and overall grumpiness follows its onset. In general, OTS leads to the lessening of enjoyment during exercise as your goals aren’t met and your motivation declines. OTS is thus mentally and physically debilitating. Yet apart from fatigue and an overall dampening to your exercise routine, OTS and its resultant drive to push harder and faster may actually lead to a number of serious and harmful consequences.
  • Exercising too much and pushing certain areas of your body to the brink and beyond often leads to disturbances which may cause short and long term damage. Examples of these types of injuries include: tendinitis; carpal tunnel syndrome; plantar fasciitis; and patellofemoral pain. Indeed, if the names don’t scare you away, then the pain associated with these conditions will.
  • Perhaps more common when it comes to OTS are symptoms you may in fact already be experiencing. These include insomnia, elevated heart rate, appetite loss, decreasing muscle mass, dwindling performance, and muscle soreness. None of these symptoms are particularly enjoyable. While you may think that exercise may actually alleviate the symptoms, the truth is that increased activity will only worsen them exponentially.

So, what can you do? You love training, your routine is magnificent, and you’ve finally mastered the art of waking up early enough to get the right amount of activity in before work. How could you possibly change anything at this point?

It’s time to start being very honest with yourself. Exercise is wonderful for you, but too much of it may actually be putting you at a disadvantage. The key is–as with so much in life–balance. It’s very important to balance the duration, type, and pace of your routines in order to make sure that no one part of your body is constantly under fire.

Although it may be difficult to accept at first, rest is just as important as exercise. It’s absolutely crucial that you give your body time off to recover and rest. This will allow your muscles to repair themselves, your joints to heal, and your endurance to be prolonged. The training cycle should consist of the right balance of training, recovery, and then adaptation.

Working out is as much about the ability to listen to your body as it is to push it to be its best. Adding a rest day (or two) to your week will actually be more beneficial to your workout than skipping them. As an extra bonus, you can sleep a bit later on those days! Balancing exercise and rest is the most effective way of staving off the risks associated with Overuse Training Syndrome. Knowing how to do this is, however, tricky for many of us.

For more information on overtraining, be sure to check out my 12 Tips to Prevent Overtraining Syndrome and 10 Tips to Self-Treat Overtraining Syndrome. In addition, you can find more recovery tips in Muscle Cramping & Spasms – Treatment Options.

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If you are interested in a more thorough look at Overtraining Syndrome and how to use overreaching as an effective training tool, be sure to check out my book on Amazon, Preventing and Treating Overtraining Syndrome. I show you how to recognize the risk factors and symptoms of OTS. You’ll learn how to utilize prevention strategies to help you develop a personal training strategy that will allow you to push past your limits and prior plateau points in order to reach a state of what is known as overreaching (your body’s ability to “supercompensate”). This will speed up your results, so that you can train harder and more effectively than ever before! In addition, learn how to use the foam roller (complete with photos and detailed exercise descriptions) as part of a health optimization program, recovery program, rest day or treatment modality.

Nothing can derail your best laid training plans and goals like an injury or suffering from OTS! If you develop OTS, you will need to take specific steps to speed up your recovery in order to prevent injury and return to a normal training schedule. Be sure to check out my book today in either paperback or on Kindle!

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