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9 Tips to Self-Treat Posterior Tibialis Pain

If you have pain along the inside (medial) portion of your ankle or even the arch of your foot, you may have posterior tibialis pain. Posterior tibial tendon dysfunction (PTTD), also known as posterior tibial tendon syndrome or tibialis posterior syndrome, can develop into a tibialis posterior tendon insufficiency which causes a fallen arch. In fact, Posterior tibialis insufficiency is one of the most common reasons for adult acquired flatfoot.

The posterior tibialis muscle is a particularly important muscle as it is used in plantar flexing the ankle (pointing the ankle/toes downward) and inverting the ankle (rolling it inward). More importantly, its role is to support the arch of the foot. Injury to this muscle is common for those that love to stay active and is common in sports with higher impact.

Posterior tibialis dysfunction can be associated with traumatic injury, such as a fall. It typically develops over time depending on your risk factors and the strain your foot has taken. PTTD is almost always progressive in nature. It begins with pain in the ankle, and then progresses to a more serious condition, such as a falling of the arch. When left untreated, this can cause adult acquired flatfoot. A fallen arch is also a common cause of plantar fasciitis.

Risk factors for posterior tibial tendon dysfunction (PTTD) include:

  • It is more common in women.
  • Those who are 40 years or older.
  • Obesity.
  • Hypertension (high blood pressure).
  • Diabetes.
  • Flat feet (sometimes called over pronation).
  • Poorly fitting or worn out shoes.
  • Poor mobility in the first (great) toe.
  • Weak ankle muscles (particularly, the posterior tibialis or the foot intrinsic muscles that help to support the arch of the foot).
  • Weakness in the hip, pelvic, and/or core muscles can lead to faulty gait mechanics.
  • A change in running surfaces or environments. This is most evident when transitioning from a softer running surface, such as dirt, to a concrete running track or running downhill. This causes overuse or overtraining of the tendon.
  • Training overload. Performing too high of training intensities and volumes. This overuse or overtraining of the tendon causes inflammation, swelling, and pain. 

Symptoms of PTTD:

  • Pain is typically located along the length of the tendon (which is located on the inside of the foot and ankle near the bump known as the medial malleolus). Pain may also occur in the foot where the tendon attaches to the navicular bone near the arch of the foot.
  • The area around the tendon is usually red, warm, and swollen due to an active inflammatory process.
  • Pain located along the tendon is worse with activity. The higher the impact, the worse the pain.

As the condition worsens, the arch will begin to flatten. The ankle and foot begins to roll in as the toes move outward with each step. In advanced cases, a person will often compensate by having the entire lower leg roll outward which often leads to knee, hip, and low back pain.

Once the arch has fallen, pain is more commonly felt on the outside of the ankle (as the posterior tibialis tendon has usually ruptured at this point).

9 Tips to Self-Treat Posterior Tibialis Pain:

Initial treatment.

This condition typically begins as an overuse syndrome with an active inflammatory cycle occurring. The initial course of treatment includes RICE, which stands for Rest, Ice, Compression, and Elevation.

Self-mobilize the tissue.

Be sure to mobilize the tissue in and around the shinbone (tibia). You could also use a tennis or lacrosse ball to aggressively work out the tissue along the shin (as demonstrated in Posterior Tibialis Tendon Dysfunction Exercises). Take care not to be too aggressive when mobilizing the posterior tibialis tendon initially or you may make the pain worse. Instead, initially focus on any other mobility and myofascial restrictions in the lower legs. Utilize a foam roller to address any lower leg tightness or restrictions. I tend to use the foam roller for the larger parts of the leg including the thigh, back of the leg, calves, and buttock muscles. Please refer to Lower Extremity Mobilizations using a Foam Roll.

Strengthen your foot and ankle complex.

Weakness in the foot and ankle muscles is a major risk factor in developing PTTD. I recommend initiating a complete ankle and foot strengthening protocol (as demonstrated in Posterior Tibialis Tendon Dysfunction Exercises).

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 mechanics, which can lead to excessive strain on the posterior tibialis tendon. Practice balancing on one foot.

If you change running surfaces, progress slowly.

If you typically run on softer surfaces, such as dirt or a running track, progress carefully and slowly to running on a harder surface (like concrete). Over all, softer running surfaces are better for your body. If your job requires that you stand on a hard surface, adding a foam pad or rubber mat can decrease the strain on your foot and arch.

Avoid training overload.

Don’t progress your training volume and/or intensity levels too quickly. PTTD is most commonly diagnosed as an overuse injury. Proper training is very important to avoid overloading your body. Improper progression of training volume and/or intensity can easily lead an overuse injury like PTTD, Achilles tendinitis or other lower extremity injuries.

Add an orthotic.

Additional foot control is often needed to normalize gait mechanics. 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.

In this video, Taping for Posterior Tibialis Tendon Dysfunction (PTTD), I demonstrate a taping technique for supporting the arch and the bottom of the foot for those suffering from PTTD.

If you continue to experience pain related to your foot or footwear, then you may need to consult with a physical therapist that specializes in feet and orthotics. A custom orthotic may be necessary to correctly support your foot and insure proper foot mechanics. Seek assistance from a professional who is a runner and has experience with treating other runners.

Immobilization.

Sometimes you may need to wear a walking boot in order to immobilize the foot and ankle complex to allow the tendon to heel. In very severe cases, you may need to completely avoid all weight bearing activities. Please seek instruction from your medical physician. If the condition worsens, it’s pertinent to intervene prior to tendon failure.

Ask for help.

If you’re still experiencing pain after implementing these self-treatment strategies, then it may be time to seek additional help. If you are not progressing after 3-4 weeks of implementing these treatment options, speak to your medical professional. Do not take this condition lightly. Other medical conditions can mimic or be associated with PTTD. Your medical physician or physical therapist can help to determine if your pain is associated with a stress fracture, plantar fasciitis, shin splints or another condition. Your physician could also prescribe a stronger anti-inflammatory medication if necessary.

The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area. In most states, you can seek physical therapy advice without a medical physician’s referral (although it may be a good idea to seek your physician’s opinion as well).

What has helped you the most to self-treat posterior tibialis pain? Please share your tips!

If you have a question that you would like featured in an upcoming video or 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 following The Physical Therapy Advisor!

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Mobility Bands: Benefits and How to Use

Mobility bands (like the VooDoo Floss Band) are gaining in popularity as a self-treatment tool particularly among the athletic population. There are many brands manufacturing mobility or floss bands with most of them being very similar. Most mobility bands utilize a long piece of thicker elastic latex rubber to compress tissue in or around varying locations. Other brands (like the CTM Band) have made innovations to the more traditional style band which allows for a more aggressive mobilization into the soft tissue. (“CTM” stands for compression, tension, and movement.)

Reasons why you may choose to utilize a mobility band include:

  • Pain modulation.
  • Decrease myofascial type pain from muscle spasms and trigger points.
  • To improve range of motion of a particular joint or tissue.
  • To decrease edema and swelling.
  • To reduce blood flow as part of a workout strategy such as blood flow restriction (BFR) training.
  • To improve blood flow as part of a treatment OR as recovery/rehabilitation strategy in order to reduce edema or swelling in an injured area.

If you suffer from any form of blood clotting disorder or are on blood thinning medications, I would advise against utilizing mobility bands for any type of deep compression.

Presently, there are few research studies on the effectiveness and efficacy of utilizing mobility bands. However, there is a lot of antidotal evidence including my own.

What we know from the existing research is that “flossing” appears to have the most impact on ankle mobility and performance. In particular, short-term increases in ankle dorsiflexion mobility can have positive effects on activities (such as squatting and single-leg jump performance) and reduce ankle pain.

Present studies investigating the effect of flossing on the shoulder and elbow joints are yet to show significant improvements in mobility or power. However, increases in elbow mobility were noted in tennis players that had an existing mobility restriction.

The exact mechanism of action on how and why mobility bands work is still under debate. The general feeling is that depending on the intended use of the mobility bands, there are likely multiple mechanisms of actions. One or more of the mechanisms are likely being emphasized to produce the desired effect. My thought is that there are three major systems affected when utilizing mobility bands: circulation (blood flow); fascial (mobilization); and neuromodulation (improved range of motion through a nervous system response).

Blood Flow

Blood flow is affected because of the amount of compression provided by the mobility band. An immediate effect on the tissues will occur. This happens when the mobility band is applied (restricting the blood flow), and when it’s taken off (allowing for a rush of blood to the area).

This can have two positive, yet different effects: to decrease swelling and to cause nutrients to be delivered to the affected tissues. If the mobility band is used over an edematous (swollen) area, then the mechanical compression from the mobility band can help to decrease the swelling. To enhance the effects of the compression, all one must do is repeatedly move the compressed area through a normal range of motion. This combines the body’s natural muscle pump with mechanical compression while more swelling maybe eliminated. This is a short term effect as the mobility band should only be applied for 60-90 seconds at a time. (This technique is probably not suitable for highly edematous areas or those who suffer from lymphedema.)

As the mobility band is removed, the body’s immediate reaction is to restore blood flow which can cause hyper perfusion of the tissues. This hopefully will cause additional nutrients to be delivered via blood flow into the affected tissues.

Fascial Mobilization

Another theory on how mobility bands work is via fascial shearing. By adding a compression force to a tissue and then sliding it back and forth, one creates a type of “tack and floss” motion that seems to affect soft tissue and fascia. This is effectively a method of self-fascial mobilization.

Compressing muscle groups and taking them through their range of motion creates a flossing effect (which is where the term VooDoo flossing came from) between individual muscles. Compressing the fascia while flossing the tissues (by moving the extremity back and forth) may break up adhesions in the fascia that exist. This will allow for better range of motion and movement while reducing pain by addressing myofascial restrictions.

The CTM Band has taken this concept and added small rubber knobs within the band to increase the intensity of the flossing. Depending on how the knobs on the band are positioned, this creates a more pin point tack and floss scenario. This particular band can be highly effective for muscle groups in the calf, quadriceps, and hamstring area. Use code MTA15 for a 15% discount. (CTM Band techniques are not typically performed during the acute phases of recovery. They are more for prevention /pre-hab or to be used during the sub-acute or chronic phases during rehabilitation/recovery.)

Along with the tack and floss theory and depending on where the mobility bands is placed (like over a knee or ankle joint); one may produce a significant enough compression force over a joint with the mobility band that it creates a distraction force. This may create extra room in the joint capsule. Mobilizing a joint with the VooDoo Floss Band allows that particular joint’s full range of motion (without restrictions). In this case, there is an actual mechanical force affecting tissue length and/or mobility. This could have a mechanical “mobilizing” effect if the capsule was tight, but it could also be affecting joint mechanoreceptors (neuromodulation).

Neuromodulation

By positioning the mobility band over a joint to cause a distraction force over the joint and within the capsule, thereby allows for improved alignment and freedom of motion within the joint. This can have a neuromodulation affect over the joint which allows for improved range of motion. Although this can be a mechanical change, it may also be a neuromuscular change where joint mechanoreceptors are activated in a positive way. This can allow you to more freely utilize the extremity that you applied the mobility band to. Neuromodulation may also be achieved just through the unique stimulation caused by the band activating neuromechanoreceptors. The mobility band likely has multiple effects at once; more research needs to be done.

How to Use a Mobility Band

When using a mobility band, you generally wrap it toward your heart. The goal is to create a large compression force around the restricted joint or tissue. To achieve this, wrap the mobility band starting 2-3 inches below the area you want to treat. Aim to finish wrapping about the same distance above the treatment location. While wrapping, overlap about half the width of the mobility band. For mobility, a stretch of around 50-75 percent can be applied to the mobility band at the area you are treating. If you have any leftover band, additional compression can be applied by making an “X” over the treatment area.

Once the mobility band has been applied, you can try moving into the position causing restriction or by moving the joint or limb in all possible directions. There are guidelines for how long to keep the mobility band on. A general rule is to aim for around 1-2 minutes.

The application of the mobility band is going to compress the underlying tissues. However, care must be taken to not over compress or injure tissues. Discontinue use if you begin to feel the following:

  • You begin to feel numbness or pins and needles (a sensation of uncomfortable tingling or prickling).
  • You suddenly feel claustrophobic.
  • You are losing volitional control of the extremity.
  • You are experiencing increased pain or instability within a joint.

The mobility band should only be applied on the extremities. It should not be applied over your trunk area or any acute injuries including fracture sites, blood clots, wounds or any tissue areas that may be extremely sensitive to compression. Do not utilize if you have any medical reason not to utilize this technique. Common sense should always be utilized when using mobility bands as a treatment modality. If you’re not sure, then please speak to a medical practitioner prior to utilization. If you suffer from any form of blood clotting disorder or are on blood thinning medications, I would advise against utilizing mobility bands for any type of deep compression.

More specific instructions and examples on how to and why you may want to utilize a mobility band as part of a rehabilitation protocol (or even just to aid in recovery after longer runs) are covered in 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.

What’s Inside the Resilient Runner Program:

  • Guidance on preventing and self-treating common running related injuries, including Hip Flexor Pain, Runner’s Knee, IT Band Syndrome, Piriformis Syndrome, and more!
  • Specific guidelines on when and how to return to running after experiencing an injury.
  • Rehabilitation guides with step-by-step photos demonstrating recommended exercises.
  • Step-by-step instructions on how to apply Kinesiological tape.
  • Downloadable podcasts, videos, and more!

If you’re tired of ongoing aches, pains, and injuries, learn how to become a resilient runner so that you can continue to train and compete in order to meet your goals!

I WANT TO BE RESILIENT!

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How to Fix a Crack in your Heel

Worrying about a crack in the skin of your heel might seem a bit odd since cracks are quite common. It’s estimated that this condition affects approximately 20% of the people in the United States with over half of the cases affecting females. These cracks are also referred to as heel fissures. They are painful and can become infected so they need to be taken seriously.

These cracks or fissures are typically associated with thickened callused areas along the heel and dry skin. If the skin is dry and callused, it doesn’t have good elasticity so the skin becomes stiff and prone to cracking (resulting in the fissures). The fissures are often associated with obesity, poor footwear or standing for long periods of time.

Risk Factors:

  • Prolonged standing.
  • Obesity.
  • Shoes without backs that allow the skin to stay open to the elements.
  • Poorly fitting shoes that cause friction or shearing in heel pad area.
  • Dehydrated skin.
  • Cold weather or very dry climates.
  • Diabetes which usually leads to poor skin healing due to its negative effects on blood flow and nutrient exchange in the lower extremities.*
  • Other skin conditions such as psoriasis, eczema or fungal infections like athlete’s foot.

*These cracks are at a high risk for infection (particularly, if you are diabetic).  See a physician right away if you are experiencing acute soreness, redness, swelling or severe pain in this area or the foot for more than a day or two.

How to Self-Treat a Crack in the Heel:

  • Identify the reason it developed in the first place. Is your skin constantly too dry or flakey? Then start a daily lotion and moisturizer routine. Are your shoes fitting properly or do you have a fungal infection that is affecting the skin? Deal with any known risk factors for the condition.
  • If you have a large callus in this area, be sure to keep the callus trimmed down and in check. You may need to initially get help from a podiatrist if your callus is exceptionally thick or if you are diabetic. Otherwise, use a heel file or pumice stone. Keep the skin moisturized through a quality lotion that does not have additional ingredients or perfumes for smell. A product like Kerasal Intensive Foot Repair Ointment can help soften very hard and rough skin along the heel.
  • While you work on keeping the area moisturized and getting the callus smaller, skin glues can be helpful to prevent the area from splitting further and to provide a barrier to prevent infection.
  • Use a product like Flexitol Heel Balm which contains 20% Urea. This can help soften the skin and reduce the callus area. If you want it to work even better, try applying a barrier cream (like petroleum jelly or lanolin lotion) over top. Consider wearing cotton socks over top of the barrier cream to help keep moisture in. It also allows the skin to breath and can prevent staining of your bedding.
  • Try to limit excessively long and hot baths or showers as this will dry the skin further.
  • Always use fragrance free products.
  • Always moisturize the area after bathing or showering.
  • Wearing shoes with a closed heel can help heal and prevent cracks to the back of the foot. Shoes with closed heels with cushioning give support to the problematic area.
  • Try to wear padded socks. Wearing cotton socks with shoes may help to reduce friction as well along the heel. Cotton socks can also soak up sweat and moisture, allow the skin to breathe, and help to prevent the skin drying out.

If the condition is severe, worsens or just doesn’t seem to heal, additional medical care may be required. A medical provider (like a podiatrist) can help:

  • Remove dead skin.
  • Prescribe stronger softening or removal agents.
  • Apply medical glue to seal cracks.
  • Prescribe an antibiotic if there is an infection.
  • Wrap the heel with dressings or bandages to protect the area and/or help it heal through different medications and bandages.
  • Recommend shoe inserts, heel pads or heel cups.

Cracked heels are common, but can be problematic and downright painful if left untreated. If you’re not experiencing relief and progressing with the heel crack significantly improving after two to three weeks of aggressively managing the symptoms, contact your medical provider.

Do you have any specific remedies for fixing a cracked heel? Please share your tips!

If you have a question that you would like featured in an upcoming video or 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 following The Physical Therapy Advisor!

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Plantar Fasciitis? Do this First Thing in the Morning

Plantar fasciitis is a very painful and potentially very debilitating condition. It’s one of the most common causes for heel and/or bottom of the foot pain. In the case of plantar fasciitis, the fascia on the bottom of the foot becomes swollen and irritated and may cause pain when you stand and/or walk. It’s typically at its worst in the morning with your first several steps after sleeping.

In this video, I demonstrate a simple, yet effective warm up to perform whenever you get up from sitting or lying down to prevent foot pain from plantar fasciitis.

Since the tissue on the bottom of the foot tightens as you sit or lay down for any length of time, be very intentional about preparing this area BEFORE you walk. This will lessen the pain and speed recovery. This is why I recommend doing this warm up throughout the day and especially, first thing in the morning.

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Be sure to check out my post, How to Self-Treat Plantar Fasciitis, for more tips! If you’re not experiencing significant relief upon progressing into your exercise program, please consult a medical professional. I recommend a physical therapist who specializes in feet or who works with athletes for the treatment of plantar fasciitis. The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area.

If you have a question that you would like featured in an upcoming video or 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 following The Physical Therapy Advisor!

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Want Stronger Hips? Do This

Many lower extremity overuse injuries can stem from poor hip strength. The hip plays a critical role in determining how the foot will actually impact the ground and ultimately how the force of that impact will translate back up the leg. In other words, the hip is a critical component of the lower extremity kinetic chain.

Weakness in the hip musculature (particularly, hip abductors and hip external rotators) will often lead to knee pain as well as many foot and lower leg overuse injuries not to mention pain in the hip itself. Plantar fasciitis as well as knee pain may be caused by hip weakness.

In this video, Hip Strengthening with Band, I demonstrate a unique and advanced exercise designed to specifically strengthen your hip and lower leg in order to address common muscles imbalances found in the hip musculature. It’s a different version of the monster walk using a pull up assistance band. Addressing these muscle imbalances can lead to the permanent resolution of your pain and symptoms.

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Be sure to check out my other videos, Treating Hip Impingement: Basic Techniques and Treating Hip Impingement: Advanced Techniques.

If you’re interested in more thorough guide along with other videos on how to self-treat lower extremity injuries and pain, check out the Resilient Runner Program. This is the perfect guide to help you take control of your health and fitness as well as self-manage common aches, pains, and injuries. Even if you’re not a runner, this program is appropriate for those who love to stay active and want to enjoy a healthy lifestyle.

If you have a question that you would like featured in an upcoming video or 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 following The Physical Therapy Advisor!

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Autoimmune Disorders: What Impedes Recovery

Autoimmune disease is becoming increasingly more prevalent. Although the exact reasons for this increase are unknown, it’s likely multifactorial. Physical therapy has been important for a long time in managing autoimmune conditions such as Rheumatoid Arthritis (RA) that have an obvious orthopaedic impact. However, physical therapists must also understand how other autoimmune disorders (such as Crohn’s Disease, Leaky Gut Syndrome, Celiac Disease, and Ulcerative Colitis) can directly and indirectly impact the plan of care and treatment recommendations.

From a physical therapy standpoint, understanding all types of autoimmune disorders and how they impact nutrient absorption is critical to positive physical therapy outcomes for any musculoskeletal diagnosis.

The following video is a portion of a lecture created for the New Hampshire American Physical Therapy Association (NHAPTA). Kim Steinbarger, PT, MHS, DHSc Candidate and I discuss the role of physical therapy in managing autoimmune disorders and how autoimmune disorders can directly and indirectly impact physical therapy treatment plans. This lecture was specifically for rehabilitation professionals, but it contains important information for anyone impacted by autoimmune disease.

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If you or a loved one need help managing an autoimmune disease, please contact your local physical therapist for an assessment. The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area.

Have you or a loved one been impacted by an autoimmune disease? 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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Fitness Exercise Won’t Help Your Low Back Pain

It’s estimated that approximately 82.1 million adults in the United States spend an estimated $28.6 billion on gym memberships each year! Now combine that staggering number with the estimated $50 billion dollars plus spent annually on back pain related issues. Even with the general fitness craze we have seen over the past years, low back pain (LBP) remains one of the most prevalent medical conditions treated in the United States and throughout the western world. It affects nearly 80% of the U.S. population at one time or another. It’s one of the top reasons for physician visits and one of the most common reasons for missed work days.

With so many active individuals and crazy fitness trends you would think that all of this exercise would actually help reduce low back pain, right? Wrong…It turns out that not all exercise (and especially, not all “core” exercise) is created equally.

It’s time to address how to safely self-treat your low back pain through movement and exercise as well as some helpful methods for a speedy recovery. (Not to mention, possibly saving you time and money by avoiding a physician visits for pain you can manage safely and independently with a little instruction.)

To safely self-treat your low back pain, first take a moment to assess your symptoms and pain level. What led to your pain and/or injury? Did the pain come on suddenly or slowly? Evaluate the severity of the injury. If you’re experiencing any of the following, please seek immediate medical attention:

  • Loss of bowel/bladder function.
  • Uncontrollable pain. The pain is so severe you cannot function or move.
  • You are losing muscle function or control. The muscles in the legs will no longer work. (This is different than pain preventing the muscle from working.) This sensation of paralysis occurs when the muscles will not actually function.
  • Significant loss of sensation in the leg or groin area. This is not a tingling sensation, but an actual loss of sensation. For example, you cannot feel the toilet paper when you wipe after using the toilet.
  • Onset of pain without any known mechanism for the injury. (Thoroughly consider your activity. Many times, a slow onset of pain begins several hours after performing an activity.)

Fortunately, most LBP is mechanical–meaning it is from a physical or structural cause and isn’t related to conditions such as cancer or infections. Most LBP will have a directional preference for extension. A majority of injuries occur when performing a forward biased (flexed movement) like chronic slouching or a spinal flexion biased movement. For discussion purposes, I will be addressing an extension biased program.

With mechanically driven low back pain, you should be able to alter and change your LBP within a short period of time. First, establish a directional preference by identifying a pattern to the pain. Does the pain get worse when you bend over or does it improve? What happens when you repeat this movement?

Determine how your pain responds. If it spreads away from the spine and down into the leg, beware that you are moving in the wrong direction. Stop that particular movement, and instead try flexion biased movements. In my experience, most episodes of LBP tend to respond better to extension biased movements. If flexion or extension doesn’t help or change the pain in any way, then you may need assistance from a medical provider.

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. We 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.

Although most LBP isn’t considered serious, the pain tends to re-occur. One major reason for this is that the deep stabilizing muscles known as the multifidus muscles reflexively shrink, weaken, and lose function. Without proper rehabilitation, the muscles will not fully recover. This increases the risk of future episodes because the spine no longer has the ability to stabilize itself normally. Not all “core” work is created equally, so the strength of these muscles needs to be addressed.

How to Safely Self-Treat Low Back Pain:

Perform Press-ups

Once you have injured your back, immediately start press-ups. Perform this exercise with high repetitions and frequently throughout the day as long as the pain does not periperalize down the buttock and into the leg and/or foot. Lie on your stomach and perform 10-20 press-ups. Move slow and easy, but work your way up to full motion multiple times a day.

Perform Standing Back Extensions

After sitting, stand up and perform standing back extensions. Ideally, perform this exercise at least 10 repetitions each time you stand.

Activate the Multifidus

Start exercises to activate the multifidus muscles as soon as possible. Think spine extensor muscle activation. Again, perform this exercise frequently during the day after the initial injury. These Lumbar Extensor Exercises are designed to progressively activate the multifidus muscles (with the final exercise being the most challenging). Once the pain subsides and muscle function improves, more advanced lumbar extension strengthening and stabilizing exercises should be performed to decrease your risk of re-current low back pain.

Don’t Sit

Walking is critical to your recovery! It’s the number one way your spine receives nutrients and disposes of metabolic waste products. Walk frequently, and try to avoid any prolonged sitting.

If you Sit, Use Good Posture

Use a McKenzie Lumbar Roll to help insure a good lumbar curve. If you can’t sit comfortably, listen to your body and don’t sit! Be sure to stand up and walk every 20-30 minutes. Stand with good posture as well.

Stretch the Muscles of the Legs and Pelvis

Hip flexor and hamstring stretches can help to reduce muscle spasms and tightness throughout pelvis area when performed daily. Stretch for at least 30 seconds at a time, 2-3 times each session.

Be as Active as You Can

Don’t stop moving, but avoid exercises that make your back hurt more. Typically, this includes flexion biased movements like sit ups. It’s important that you remain as active as you can. You may need to taper down certain activities that you know will increase your pain. This typically would be activities involving heavy loading of the spine such as squats with weight, deadlifts, and other activities that may cause forward flexion (particularly under a load).

As you are able to, continue to work on cardiovascular conditioning and core muscle activation (particularly, the lumbar extension exercises). Basically stay as active as you can, even lifting weights if you are able.  Just remember the concept of peripheralization and centralization. If your pain progresses from the area of the injury into your leg, then you need to stop that activity. If the pain remains constant or is progressing out of the leg, then continue with the activity as you are helping the body to heal.

Developing adequate strength in the lumbar extensor muscles and core musculature is the primary way to prevent initial episodes and to prevent reoccurring episodes of LBP. Research clearly indicates that the right targeted exercises are the most effective way to manage LBP. 

If you’re not sure how to effectively and safely exercise your back or if you’re already experiencing low back pain, be sure to check out my Treating Low Back Pain (LBP) during Exercise and Athletics Book and Video Package. USE DISCOUNT CODE LBP AT CHECKOUT FOR 15% OFF!

For the approximate price of just one co-pay to see a doctor, you will receive my easy to read book with step-by-step instructions and a complete video package designed to help you prevent and self-treat reoccurring low back pain episodes.

Want to peek inside the video content? Watch now as I describe what really the “core” is and why it matters.

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If you have a question that you would like featured in an upcoming video or 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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Why We Can Be Our Own Worst Enemy

I must warn you that this is not the typical post from me. All of the information is true and sadly, not exaggerated in any way. My hope in documenting this true account of events is that it will help others know how to better avoid injury. If you do develop an injury, then maybe some of my self-treatment strategies could be helpful.

What most people don’t know about me is that I have struggled with low back pain (LBP) for over 20 years. Early on, I had years of constant and chronic LBP. This pain helped drive me to seek out different self-treatment methods. I began to understand LBP along with the best practices on how to self-manage and most importantly, avoid future flare-ups. This has personally helped me manage my own pain while helping thousands of others either directly with physical therapy or by sharing my book, Treating Low Back Pain during Exercise and Athletics.

Even with all my diligent efforts (most of the time), the occasional LBP flare-up occurs. Unfortunately, the last incident was due to poor judgement on my part. In early November of last year, I had been sitting a lot while working on a few projects, and my back started to ache. It was mild at first. However, by mid-month, I could hardly get out of a chair and walk.

As a physical therapist (PT) that specializes in treating LBP, I should have known better, but I chose to do what most people do. I ignored it, and pressed on. I reminded myself that I’ve had this pain before, and it typically goes away. Right then, I didn’t have time to address it.

Monday morning rolled around, and I was scheduled for my 5 mile tempo run. As any runner or exercise enthusiast knows, if it’s scheduled, then it must be done (no matter what, right?). I was sure my back would loosen up as I ran. Often times, a warm up prior to running makes it feel better. (If I was being honest, the pain was pretty bad that particular morning. It was preventing me from sitting, getting out of my car, and even walking straight. Was that a good enough reason to cancel a run?)

I managed a short walking warm up since that was all I could muster and proceeded into a slow jog. About 2 miles into my jog, my right calf started to hurt. Why stop? I was sure it would all shake loose soon…

As mile 3 approached, I was falling apart. My back hurt to the point I couldn’t stand up straight. My right calf was completely locked up. It was giving me a sharp pain with every step. The bottom of my left foot started aching. I finally shut it down and limped home.

Later that day, my calf wasn’t any better (neither was my back), and now I had full on plantar fasciitis. Pretty good start to the week, but I got that run in. By the end of the day Monday (post run), I was miserable, but I didn’t dare tell anyone.

As a PT, I should have known better. I started to analyze exactly what was going on. For some reason, my disc bulges (a pre-existing problem at L4/L5 and L5/S1) had flared up for no apparent reason and were hurting terribly. My back pain had caused a left lateral shift in my spine, which meant I couldn’t stand normally. The nerve tightness down my left leg affected my walk, so I could not fully stride out.

In hindsight, my sad attempt at a run early that morning was actually a terrible idea! I had obviously been running with a poor gait pattern. This altered gait pattern with poor running mechanics resulted in a right calf strain and the development of plantar fasciitis in my left foot. (And this all started in 3 miles!)

My initial treatment was to determine my directional preference for my lumbar spine pain:  

A directional preference is a way to identify a pattern to the pain. Does the pain get worse when you bend over or does it improve? What happens when you repeat this movement? Determine how your pain responds. If it spreads away from the spine and down into the leg, beware that you are moving in the wrong direction. Stop that particular movement, and instead try moving in the opposite direction. If you were moving into flexion, try extension. If you had trialed extension biased movements, try flexion. Find the movement pattern that helps the pain improve and that has a positive effect on any other symptoms you may be having.

I determined my directional preference. As I performed my series of movements, my symptoms were peripheralizing (returning back to the middle of my back to the point I could stand straight and walk normal).

After a series of 10 side glides followed by 10 press-ups (as demonstrated below), I could eliminate 75% of my LBP and symptoms as long as I didn’t sit. Sitting would immediately bring the pain back on. For the next several weeks, I avoided sitting at all costs including during dinner.

I also started back extensions over an exercise ball (3 sets of 15 repetitions as demonstrated below) every morning as part of a lumbar strengthening program. I chose back extensions to insure that I was working my lumbar extensor muscles. I kept my movement patterns within my directional preference. This was preceded by and followed by side glides and press-ups as well as continuing to avoiding sitting. I stopped running since I couldn’t fully walk or jog without an altered gait pattern.

For my calf, I started foam rolling and stretching regularly. I used a mobility band (as demonstrated below) as a way to provide compression while I performed heel raises (typically a set of 20-30 repetitions). Thankfully, I had the opportunity to trial a product that not only utilized the compression from the mobility band, but added a way to self-mobilize the calf. The CTM Band worked exceedingly well for this. (“CTM” stands for compression, tension, and movement.) Use code MTA15 for a 15% discount. (If you suffer from any form of blood clotting disorder or are on blood thinning medications, I would advise against utilizing mobility bands for any type of deep compression.)

For my plantar fasciitis, I also performed calf stretches as well as used a small ball (as demonstrated below on the left) to mobilize the bottom of my foot. Pain in the morning seemed to be the biggest issue, so I would sit up and stretch before getting out of bed (as demonstrated below on the right). By the end of the day, my foot would really start to hurt. Since I was unable to sit due to my back, I used a padded stool to kneel on whenever possible.

I continued this treatment plan for over 3 weeks. For the first 2 weeks, I was unable to run, so I concentrated on rehabilitation exercises only. During this time, I utilized a self-prescribed course of over-the-counter Ibuprofen (anti-inflammatory). I didn’t have any medical issues with taking this medication. Please consult your physician before taking any medications or supplements.

I also initiated a supplementation protocol consisting of adding collagen hydrolysate to my daily smoothie as well as taking CapraFlex by Mt. Capra. (It combines an organic glucosamine and chondroitin supplement with other natural herbs and enzymes which are designed to reduce inflammation, promote bone and joint healing, and wellness.)

This continued for approximately 4 weeks. The rationale behind the supplementation was to insure that my body had the necessary building blocks to heal and to provide additional anti-inflammatory support to my body during my recovery.

After 3 weeks, I returned to running for only shorter distances (under 5 miles). I was tapering back into other exercise routines with appropriate modifications which included increasing my warm up and cool down times and avoiding bending forward since I wasn’t 100% better.

The reason I chose to share my most recent LBP episode with you is because I have heard versions of this story over and over again from other runners, weekend warriors, and patients.  We really can be our own worst enemy!

As a PT, I should have known better than to run that day. As a runner and weekend warrior, the feeling that it may be a “mortal” sin to miss a scheduled run or work out can be a powerful temptation to do it even though your body may be telling you to reconsider.

As any frequent exerciser knows, a few aches and pains is par for the course. In fact, it’s pretty normal! Oddly, I will have just as many if not more, aches and pains when I stop running and exercising as when I’m regularly training.

The moral of my story is a reminder to be very self-discerning and self-aware to understand what is a typical ache and pain versus something more serious. In my case, not being able to walk normally due to pain should have been a clue not to run abnormally either. My abnormal running pattern that day is what led to the overuse injuries in both my calf and foot. What was surprising even to me was how fast the pain developed and turned into a true overuse injury in only the course of 3 miles!

If you’re not sure how to effectively and safely exercise your back or if you’re already experiencing low back pain, be sure to check out my Treating Low Back Pain (LBP) during Exercise and Athletics Book and Video Package.

Treating low back pain does not need to be difficult or expensive. For the approximate price of just one co-pay to see a doctor, you will receive my easy to read book with step-by-step instructions and a complete video package designed to help you prevent and self-treat reoccurring low back pain episodes.

USE DISCOUNT CODE LBP AT CHECKOUT FOR 15% OFF!

SAVE 15% NOW!

If you have a question that you would like featured in an upcoming video or 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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Why Does My Lower Back Hurt?

Have you ever wondered what exactly makes your back pain worse? Why does your back continue to hurt on and off again? Why does it seem to “act up” right at the wrong time? Is it something you are doing? Is there something seriously wrong? Is it just bad luck?

These are all fantastic questions. It’s time to answer the age old question as to why your back keeps hurting. Here are the top reasons why your back may be hurting and what to do about it.

The Top Reasons Why Your Back may be Hurting:

You smoke or vape.

Smoking is a major risk factor for low back pain (LBP). The chemicals in cigarette smoke affect both the lunges’ ability to exchange oxygen and the body’s normal healing response. These chemicals alter the blood supply to the discs and other spinal structures which affects nutrient exchange and increases the risk of pain. Healing time for all medical conditions worsen with smoking.

You’re biologically male.

Males have a higher risk of LBP. Females tend to experience more cervical or neck pain. (Obviously, you have very little control over this factor other than the knowledge that you’re at an increased risk if you are a male.)

It may be your parents’ fault.

A family history of low back pain increases your risk. In some cases, this may be due to actual structural deformities which may be genetically linked. More commonly, it’s a learned behavior, such as chronic sitting and slouching (poor posture), that can lead to a higher risk of LBP.

You’re pregnant.

Pregnancy increases your risk for LBP due to structural changes as the baby develops and hormones change. The expectant mother releases relaxin, a hormone which loosens the whole body, to prepare for the baby’s delivery. Again, a risk worth taking! Most women can manage the pain by modifying posture and movements while learning techniques for self-management.

You don’t exercise.

A sedentary lifestyle will increase your risk for LBP. The spine is designed to work and move. In order for the spine to remain healthy, it requires exercise and movement.

I WANT TO GET RID OF MY BACK PAIN NOW!

You sit for more than 2 hours a day.

Sitting for a long period of time not only affects your general health status in a negative way, but it also increases your risk for LBP. It’s even worse if you’re a heavy equipment operator who sits on a vibrating surface.

You have poor posture.

In western culture, we spend most of our day sitting slouched or standing hunched over. This is an excellent way to increase your risk for LBP. It’s one of the major risk factors for disc herniation and development of spinal stenosis.

You don’t warm up before exercise.

This is a common mistake which can lead to injury. Jump out of your bed in the morning without warming up, and then start your exercise routine. (Please don’t!) Instead, prepare your body for challenging activities in order to avoid injury. A warm up should consist of a cardiovascular component and a dynamic stretching routine of the actual exercises you will be performing to insure you’re ready for the movement. This is also pertinent for weightlifting and running.

You keep moving even when you’re exhausted.

This is a common problem among CrossFitters (including myself). Just keep pushing yourself even when you can’t see straight. Typically, this results in poor technique which further increases your risk. Combine poor technique with muscles which can no longer perform the proper movement pattern, and you’re likely to become injured. High Intensity Training (HIT) is a wonderful form of exercise and has many health benefits as long as you’re able to properly perform the exercise.

You’re using poor technique.

Poor technique, along with feeling exhausted, often occurs when performing exercises that are too advanced. Performing unfamiliar lifting techniques or lifting too much weight will likely result in poor technique. Please see your coach, athletic trainer or physical therapist for the proper technique for your activity of choice.

Your training volume is too high.

Who needs a rest day? ALL of us can benefit from taking a break. Training every day without regard to rest is an excellent way to cause over training syndrome and injury to your back.

You’ve experienced prior episodes of LBP.

Once you have experienced LBP, you are more likely to have re-current episodes. This may be the major reason why your low back pain re-occurs. This is partially due to weakness in the deep multifidus muscles that help support the spine and prevent shearing forces. This weakness can be addressed with proper physical therapy intervention. The loss of structural strength is the primary reason why your back pain continues to re-occur, and this can be changed.

Core strength does matter, but it is likely not what you think. Most people don’t quite understand the relationship between the “core” and lumbar stabilization. It’s way more than just doing sit-ups. In fact, sit-ups may actually make your back pain worse.

Low back pain is a serious and debilitating condition. It will either most certainly affect you or someone close to you. Be mindful of your risk factors and be pro-active in maintaining a healthy back! The good news is that nearly all low back pain is mechanical (meaning there is a physical reason for the pain). There are physical treatment options that not only can help you recover from the pain, but also to avoid re-occurring back pain!

If you’re not sure how to effectively and safely exercise your back or if you’re already experiencing low back pain, be sure to check out my Treating Low Back Pain (LBP) during Exercise and Athletics Book and Video Package.

Treating low back pain does not need to be difficult or expensive. For the approximate price of just one co-pay to see a doctor, you will receive my easy to read book with step-by-step instructions and a complete video package designed to help you prevent and self-treat reoccurring low back pain episodes.

USE DISCOUNT CODE LBP AT CHECKOUT FOR 15% OFF!

SAVE 15% NOW!

If you have a question that you would like featured in an upcoming video or 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 Prevent Back Pain while Working from Home

The COVID-19 pandemic has transformed work and how it is done. Many people transitioned from working in an office setting into working remotely from home. Many employers have extended work-from-home (WFH) options as coronavirus cases continue to surge. With the shift of working environments, there has been a rise in back pain and other posture and structural driven pain from the neck, shoulders, arms, and low back. Much of this increase in pain is due to poor home working conditions and more sedentary behavior as we spend more time at home during the COVID-19 pandemic.

Low back pain (LBP) continues to affect nearly 80% of the U.S. population at one time or another, and it’s one of the top reasons for physician visits. Yet most of us do not currently seek care or in some cases, we cannot even get appointments into our medical providers because of the pandemic.

Fortunately, most LBP is mechanical–meaning it’s from a physical or structural cause not related to conditions such as cancer or infections. The problem with this type of LBP is that it usually comes back. People who have had an episode of mechanical LBP are 90% more likely to experience it again. It’s best to minimize your risk factors for experiencing LBP by being pro-active. This means that you can effectively self-treat YOUR low back pain without expensive medical visits, surgery, pills or injections.

How to Prevent Back Pain while Working from Home:

Fidget more. Limit the amount of sitting that you spend at one time. Since you’re at home, you can sit in different positions and in different locations. Get out of a sitting position every hour, and ideally, walk. If you aren’t able to walk, then try to shift your position at least once every twenty minutes.

Frequent position changes can help to avoid LBP. Don’t get stuck sitting for hours in the same position (particularly, if it’s uncomfortable or if you’re sitting with poor posture or with poor ergonomics). If you’re standing, then stand in different positions. Put your foot up on a stool, and then switch feet. Stand on different surfaces when possible (hardwood, carpet or softer padding like a standing mat). Variety is the key to avoiding low back pain.

Sit with good posture. If you’re going to sit for any period of time (regardless of the position), maintain your posture. Whenever possible, make sure that your knees stay below your hip level and that you are able to maintain your natural lumbar curve. Even if you don’t have an office chair at home, lean back in the chair (don’t slouch in your lower back). A great tool to help you with this is a lumbar roll. Ergonomics are important, so find ways to support your back while keeping your shoulders and neck in a relaxed position.

Stop looking down. Try to keep your devices at eye level, or slightly down. Don’t position them so that you have to look up at them. Limit the amount of time spent looking down whether that is from texting or reading a paper or even writing. If you tend to spend 30-40 minutes at a time looking down at your device, work toward reducing that time in half.

I WANT TO GET RID OF MY BACK PAIN NOW!

Stand more. A standing desk can be a wonderful luxury. At home, you can get creative and use a higher counter top for a make shift standing desk. Use boxes or books to improve the ergonomic positioning. The set up should allow you to look straight ahead when you work on your computer while in a position that your arms can hang down naturally with the forearms supported. No one can see your set up. Even if it’s not esthetically pleasing, it’s best to keep your body feeling good.

Take a break to exercise. Take advantage of being home and take a 15 minute stretching or yoga break. How about 10 minutes to roll out and utilize the foam roller or maybe a few core exercises like planks? Have some fun with it. My favorite 10 minute work-from-home exercise break includes: 25 air squats, 25 push-ups, 5 minutes stretching on the foam roller, and then a few press-ups.

I highly recommend press-ups. Lie on your stomach and perform 10 to 20 press-ups. Go slow and easy, but work your way up to full motion. Perform these multiple times a day as time allows. This is much easier to do when working from home versus an office environment.

Developing adequate strength in the lumbar extensor muscles and core musculature is the primary way to prevent initial episodes and to prevent reoccurring episodes of LBP.  Research clearly indicates that the right targeted exercises are the most effective way to manage LBP.

If you’re not sure how to effectively and safely exercise your back or if you’re already experiencing low back pain, be sure to check out my Treating Low Back Pain (LBP) during Exercise and Athletics Book and Video Package.

For the approximate price of just one co-pay to see a doctor, you will receive my easy to read book with step-by-step instructions and a complete video package designed to help you prevent and self-treat reoccurring low back pain episodes.

Want to peek inside the video content? Watch now as I describe what really the “core” is and why it matters.

WATCH NOW

If you have a question that you would like featured in an upcoming video or 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!