Tag Archives: CapraFlex

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Why You Won’t Heal – Part 4

Poor Nutrition

There are many reasons and factors that affect a person’s ability to heal and recover from an injury or illness.  One of the most common, yet the most basic, reason is poor nutrition.  The healing tissue and the body may not be receiving the proper base components to actually heal.  In Part 4 of the series, Why You Won’t Heal, I address how poor nutrition can negatively impact how one heals from an injury or illness.  Consuming the right foods to provide the proper nutrients for your body is critical in order to fully heal and recover from an injury or illness.

Two Reasons Why Nutrients aren’t getting to the Injured Area:

1. The injured area or tissue just isn’t getting adequate nutritional and growth factors to the actual tissue. 

This is a logistical delivery issue.  For example, the blood supply to the injured area may be compromised.  Without a proper blood supply to the healing tissues, the area will not receive vital nutrients and healing factors which is a critical component of the healing process.

One possible reason for poor blood supply may be due to dysfunction in one’s cardiovascular system (such as heart disease or atherosclerosis, the hardening and narrowing of the arteries).  Another reason may be that the injury is to a tissue that inherently has a poor blood supply such as cartilage tissue.  In the case of lumbar discs, they rely more on movement than blood supply to circulate nutrients.

If it’s not a delivery issue, then there are cases where it may be an absorption issue.  This can occur in the case of a digestive related issue that affects the body’s ability to actually get the needed nutrients from the consumed food into a useable form in the body.  This includes conditions such as Crohn’s disease and leaky gut syndrome.

2. A person’s food choices and lifestyle are not allowing for the body to have the base nutrients needed to actually heal from the injury. 

Sadly even in western societies where food is overly abundant, so is malnutrition.  I work with clients who are obese and have access to an adequate amount of food with plenty of caloric intake to survive, yet they are so nutrient deficient that their rehabilitation potential is very poor.  An abundance of food and calories does not necessarily equal adequate amounts of nutrients and micronutrients to be healthy.  This is the primary problem behind our obesity epidemic including metabolic syndrome, diabetes, and heart disease.

As a physical therapist, I help to educate my clients about a wide variety of strategies from advice on exercise, hands-on techniques (such as myofascial and joint mobilizations), and self-care techniques (such as basic nutrition) because it’s a critical component in how a person can heal and recover from an injury or illness.

Many of my clients have the following conditions which have a nutritional component to them:  osteoporosis; sarcopenia; autoimmune diseases; metabolic syndrome; diabetes; and heart disease.  Even when a client doesn’t have a specific systemic condition, proper nutrition is still a factor on how an injury will heal whether it’s from an ankle sprain or from a knee or a shoulder surgery.

Often times, I will work with a physician, registered dietitian or nutritionist to help educate my client on proper eating habits.  I also commonly refer clients to certain books, such as Dr. Josh Axe’s Eat Dirt: Why Leaky Gut May Be the Root Cause of Your Health Problems and 5 Surprising Steps to Cure It, which can help to educate them on number of different topics.

As a physical therapist, it’s not uncommon for me to see someone who is struggling with healing from an injury.  He/she may be performing the right exercises and receiving the proper treatment, yet he/she is unable to properly heal because his/her body doesn’t have the proper nutrition level to allow the healing to occur.  It is important to remember that poor eating habits not only sabotage your results, but can also lead to severe chronic illnesses.

Focus on your Recovery Nutrition

In order to fully heal and recover from an injury or illness, consuming the right foods to provide the proper nutrients for your body is critical.  The majority of your diet should be from real food.  My personal belief is that food which is minimally processed, organic and/or home grown is likely to have a higher nutrient load and will therefore be healthier for you.  Your body simply cannot heal and recover quickly or adequately when substandard fuel “food” is consumed.

In today’s society, it’s possible to have an overabundance of calories and still be nutritionally deficient and malnourished.  It’s critical to focus on nutrient rich food and avoid “empty” calories.  That includes food which has no nutritional value (junk-food).

Maintaining muscle mass is critical for recovery and rehabilitation as well as for injury prevention.  Initially, focus on macronutrients (fat, protein, and carbohydrates) when it comes to food.  During the rehabilitation process, focus on a diet high in protein from many sources (plant and animal-based), high in fruits and vegetables, and low in processed carbohydrates.

Newer research concludes that as a person ages, his/her protein needs do not actually decrease, but remain elevated as the body’s ability to process protein decreases.  It’s important to have higher amounts of protein available for use.  During recovery, additional protein is often needed to insure healing tissues have the building blocks necessary for recovery.  For more information on protein supplementation, please refer to How Much Protein Do I Really Need?

Each person is different as is the recovery process and one’s prior health status.  The diet should be tailored to your individual needs.  There isn’t just one perfect diet plan—these are only guidelines.  Please discuss your dietary concerns with your medical provider.

Supplementation

The ultimate goal with supplements is to aid your body in improving health and nutritional status.  Try to choose the most natural products as possible and experiment to see what works best for you.  Look for supplements that don’t contain extra fillers, sweeteners or additives.

The following list includes my most common recommended supplements to take during the rehabilitation process:

Protein

Protein is a critical macronutrient that is highly important in maintaining the building blocks needed to support the muscular system (including skin and tissue).  Additional protein is often helpful during the recovery process if you have experienced a muscle or tissue injury.  Additional protein in your diet can stabilize blood sugars and satiate your appetite.

Capraflex

My most recommended supplement to help recover from injury is CapraFlex by Mt. Capra.  It combines an organic glucosamine and chondroitin supplement with other natural herbs which are designed to reduce inflammation.  CapraFlex can be taken long term or intermittently.  I use it to help recover from acute injury.

Magnesium

Magnesium is a critical component of bone health and health in general.  Magnesium helps the body to regulate calcium levels.  This has a positive effect on bone health and also has been proven to reduce the risk of kidney stones.

You can take Mag Glycinate in pill form or by eating foods higher in magnesium such as spinach, artichokes, and dates.  Most people are deficient in the amount of magnesium they consume on a regular basis.  I recommend beginning with a dose of 200 mg (before bedtime) and increasing the dose in 100 mg intervals as needed.  I would caution you that taking too much magnesium can lead to diarrhea.  Mag Glycinate in its oral form is the most highly absorbable.  Although not as absorbable, Thorne Research Magnesium Citrate and magnesium oxide can also be beneficial.

Vitamin D3

Vitamin D3 is critical to the absorption of calcium through the intestinal wall which is important for bone health.  It’s also a critical nutrient in maintaining a healthy immune system.  However, there are potential cardiac risks to over supplementation.  A healthy varied diet will typically supply adequate calcium levels (assuming that adequate Vitamin D3 levels are present for absorption and that you are avoiding drinking soda).

Vitamin K2

Research indicates that Vitamin K can help to reduce bone loss by helping the body regulate osteoclast function within the bone.  An osteoclast is a type of bone cell that breaks down bone tissue.  These very important cells are integral in maintaining proper bone density and insuring an appropriate amount of calcium in the blood stream.  Without adequate calcium, many critical cell functions can be affected (including heart function).  Both Vitamin K1 and K2 have been proven to reduce the risk of fractures, including hip and vertebral.  Vitamin K (best found in green leafy vegetables) has anti-coagulation benefits.  If you take blood thinning medications, your physician will need to know how much you consume on a regular basis.

Coconut Oil

In past years, there has been a real push for toward a low fat diet.  However, people have forgotten that fats are a critical macronutrient when consumed at reasonable levels and via real foods (such as coconut oil or avocados).  The nervous system relies on adequate levels of fats and cholesterols to be present.  Insuring the proper amount of fat consumption is critical when healing from a neurologic injury or condition.  It’s also helpful for weight loss because it can satiate your appetite.

Super Greens

Green super foods, such as spirulina algae, chlorella algae, and wheat grass are packed high in antioxidants.  They can have a cleansing and an alkalizing effect which will decrease your inflammation level and aid in recovery.  Super greens boost your immune system and are generally good for you.  I think the argument can be made that algae is the king of “super” foods.  It is likely the most important food/supplement most people are not taking.

I am particularly fond of supplementing with algae as a super food because it addresses many of the most common nutrients needed during rehabilitation.  Algae have high levels of protein as well as magnesium and other critical micronutrients in order to help you recover.

My new favorite way to add greens and protein in general is a supplement called ENERGYbits® and RECOVERYbits®.  They are made from organically grown NON GMO spirulina algae or chlorella algae.  Spirulina algae have a high concentration of plant-based protein (64%).  It also contains 40 vitamins and minerals including iron, nitric oxide, Omega-3, and all of the B vitamins.  Chlorella is high in protein.  It also has detoxing properties and an impressive micronutrient profile.

Because of their overall nutritional profile I now consider spirulina and chlorella algae a top rehabilitation and recovery supplement.  I recommend taking 30-45 of these small tablets per serving.  I recommend swallowing them whole, but you can chew them.

If you want to learn more about algae be sure to listen to Ben Greenfield’s interview with the founder of ENERGYbits®, Catharine Arnston, on the benefits and importance of algae.  Please refer to Is This The Most Dense Source Of Nutrition On The Face Of The Planet?

In full disclosure, I am now an affiliate for ENERGYbits®.  I signed up primarily to get the same 20% discount I can offer you.  You can only purchase them online, so when you check out, just enter discount code PTAdvisor for 20% off all products.

BUY NOW

Adequate nutrition is an important component to the rehabilitation and recovery process.  There is a direct correlation between your nutritional status and your ability to heal.  Each of us has different needs based on our individual health status.

As a physical therapist, I offer general guidelines based on what has worked for my past clients.  However, I recommend that you find a nutritional expert to be part of your rehabilitation team as well.  If you are not healing from your injury, it’s very important to insure that any and all dietary concerns are properly addressed.  Don’t skip this step as poor nutrition can and will derail your recovery process.

Have your food choices positively or negatively affected your recovery from an injury or illness?  Which supplement might you consider taking?  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

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Q & A: What to Expect after Breaking a Collarbone

Q.  I fell snowboarding last weekend, and I broke my collarbone. My doctor says that I don’t need surgery and that I will be fine in a couple of months.  I want to be more proactive than that.  What should I do? -Shawn

A.  Thanks for the question, Shawn. I’m sorry to hear about your snowboarding accident.  Fractures of the collarbone (clavicle) are actually fairly common and typically result from falling on the shoulder, the collarbone or an outstretched hand.  Collarbone injuries are also very common in toddlers, typically due to a fall out of bed or tripping when running.

The collarbone attaches the sternum to the scapula (shoulder blade). Many important structures, such as nerves and blood vessels, lie just below the clavicle. However, these vital structures are rarely injured when the clavicle breaks.  Diagnosing a clavicle fracture is typically performed via X-ray. In certain circumstances, a CT Scan may be performed for a more thorough image of the injury.

RightClavicleFracture

Symptoms of a Collarbone Fracture include:

  • Pain in the shoulder or over the collarbone.
  • Difficulty raising your arm due to pain.
  • Slumping or sagging of the shoulder, typically downward and forward.
  • A grinding sensation in the collarbone area when attempting to raise the arm.
  • A “bump” forms over the collarbone. In severe cases, the bump will be similar to a piano key sticking up and will be mobile.
  • Bruising and swelling over the collarbone area.

Surgical Intervention

Depending on the severity of the injury, surgery may or may not be indicated. In most cases, a simple fracture (where the bones are still aligned) will not require surgery.  Even in cases of minor malalignment, most people will not undergo surgery.

Surgical fixation is most common when there is a significant displacement or malalignment present. The purpose of surgical fixation is to hold the bones in place while they heal.  The physician will either utilize a metal plate and screws or small pins to hold the bones in place.  Although the surgical hardware can be removed once the bones have sufficiently healed, often it will remain throughout a person’s lifetime.

Rehabilitation post-surgery is fairly straight forward and is similar to the following nonsurgical treatment recommendations. Please follow your physician’s recommendations after surgery as each procedure can be different.  Variations in recovery and rehabilitation can occur and are dependent on: the area that was fixed; the severity of the fracture; and the stability of the bone and fixation.  These factors will determine how quickly you can progress through the rehabilitation.

Nonsurgical Treatment Recommendations

Most collarbone fractures do not require surgery (particularly, if the fractured area retains its alignment). Your physician will assess the severity of the fracture.  This will determine how quickly you can progress through the stages of treatment.

A general time frame for healing (with an initial return to function) is on average 6 weeks for adults and about 4 weeks for children. Complete bone healing, remodeling, and a full return to all activities will take longer.  This will depend on your age, health status, and the severity of the injury.

PRICE (Protect, Rest, Ice, Compression, and Elevation)

  • Protect. In many cases, you will be advised to wear a sling (particularly, during your daily activities). This will help to protect the area from too much motion and activity while allowing the bone to heal in its proper place. It will also indicate to others that you have an injury, so that they may avoid knocking into you.
  • Rest. Allow the arm and shoulder time to rest and recover. Do not utilize the arm for activities that cause pain. Avoid excessive motions and use. As the pain subsides, you can slowly taper up the use of the arm by starting with simple daily activities.
  • Ice. Apply ice to the painful area–typically the sooner, the better. The rule for icing is to apply ice no more than twenty minutes per hour. Do not place the ice directly against the skin, especially if you are using a gel pack style. A bag of frozen peas can be ideal. Individuals with poor circulation or impaired sensation should take particular care when icing.
  • Compression. It’s not easy to apply compression in this area. In most cases, it’s not necessary. In some cases, a simple ACE wrap can be used around the shoulder and collarbone area to help reduce the pain. The wrap is typically applied to help hold the shoulder in a backward and slightly downward direction.
  • Elevation. Elevation is typically not necessary unless you are experiencing excessive swelling in the affected arm and hand. You can position the arm in a slightly elevated position by using pillows while lying on your back or on the non-affected side. This would be an excellent time to apply ice, too.

Sleeping

When sleeping, try not to lie on the affected side. Hug a small pillow for comfort.  This also promotes optimal blood flow to the shoulder area.

Pain Management

Initially begin with PRICE (Protect, Rest, Ice, Compression, and Elevation).  Pain medication, such as acetaminophen, is always an option if recommended by your physician.  You may also want to consider utilizing topical agents, which can help to decrease pain and muscle spasms. The method of action varies greatly according to the product used. You may find that one product works better than another. Some of my favorite products in my medicine cabinet include: Biofreeze Pain Relieving Gel; Arnica Rub (Arnica Montana, an herbal rub); and topical magnesium.

Another option is oral magnesium. You can take Mag Glycinate in pill form or by eating foods higher in magnesium such as spinach, artichokes, and dates. Taking additional magnesium (particularly at night) can help to reduce muscle cramps and spasming. It is also very helpful in reducing overall muscle soreness and aiding in a better night’s rest. Most people are deficient in the amount of magnesium they consume on a regular basis. I recommend beginning with a dose of 200 mg (before bedtime) and increasing the dose as needed. I would caution you that taking too much magnesium can lead to diarrhea. Mag Glycinate in its oral form is the most highly absorbable. Although not as absorbable, Thorne Research Magnesium Citrate and magnesium oxide can also be beneficial.

Supplements

Mt. Capra, an organic goat farm in eastern Washington State, offers superior quality products primarily utilizing goat based products. CapraFlex by Mt. Capra is the best bone and joint supplement I have found. It is a blend of natural herbs and spices along with glucosamine and chondroitin.  The herbal and spice formulation is designed to naturally decrease inflammation and support healing.  I recommend it to anyone recovering from an injury or attempting to prevent injury when performing at a very high level.  I personally use it, and in my practice, it has helped clients recover faster and prevent injury.  It can interfere with some blood thinning medication, so if you are on this type of medication, please check with your physician.

Vitamin D3, such as Viva Labs Vitamin D3, is critical to the absorption of calcium through the intestinal wall which is important for bone health.  Although calcium is a critical component of bone health, I cannot recommend extra supplementation because of the potential cardiac risks to over supplementation.  A healthy varied diet will typically supply adequate calcium levels (assuming that adequate Vitamin D3 levels are present for absorption and that you are avoiding drinking soda).  Vitamin D3 is also a critical nutrient in maintaining a healthy immune system.

Be sure to maintain a generally healthy diet. Give your body the needed nutrients to heal and recover quickly.

Range of Motion

Depending on the severity of the fracture, you will likely have to limit the range of motion (ROM) of the shoulder to less than 70-80 degrees of flexion (forward) and abduction (sideways) motion. You will also have to limit reaching behind your back. A person may typically wear a sling for 2-4 weeks while limiting the motion.

The initial treatment to maintain ROM is to perform the pendulum exercise (as demonstrated in the picture on the left down below). Bend forward at the waist, and let your injured arm hang down toward the ground. Make small circles with your hand, and let the momentum move your arm around effortlessly.  Try to make both clockwise and counterclockwise circles. For more instruction, please watch How to Properly Perform Pendulum Exercises.

PendulumExercise_ShoulderPulleyExercise

Around the 2-4 weeks mark, you can begin to work on regaining full forward flexion by using an over-the-door shoulder pulley (as demonstrated in the picture on the above right). Work slowly on motion for 5-10 minutes at a time. You may push though minor discomfort, but you should never experience significant pain during this process. For more instruction, please watch How to Use Shoulder Pulleys to Regain Shoulder Motion.

As flexion improves (typically after the 4 weeks mark), then you can begin to work on all other motions of the shoulder. This includes motion out to your side (abduction) and behind your back (internal rotation). The shoulder pulley can be utilized to regain these motions as well. Otherwise, you could walk your fingers up the wall when facing forward to regain flexion and sideways to regain abduction. You could use a towel to regain the motion behind your back.

Strengthening

Initially avoid lifting anything over 5 pounds. Typically around the 4-6 weeks mark (depending on severity of injury), you can begin a gentle rotator cuff strengthening program. These exercises should always be performed pain free and initially, the resistance will be very light. For specific exercises, please refer to Rotator Cuff Exercises.

The rotator cuff is a critical component to shoulder mobility. It is made up of four different muscles whose job is to make sure that the ball of the humerus (arm bone) rotates and slides properly in the socket, which is made up of the scapula. The rotator cuff allows the other major muscles of the arm, such as the deltoid and Latissimus dorsi (lats), to properly move the arm.

When there is weakness or dysfunction, it will cause rubbing of the muscle tendon on the bone. This can lead to impingement or eventually fraying and tearing. Insuring proper strength in the rotator cuff after a collarbone injury is an important component in avoiding shoulder impingement syndrome.

Return to Full Activity

Around the 8-12 weeks mark, you will likely consult with your physician to have another X-ray taken.  Once you’re cleared by your physician, you can slowly taper back into more strenuous exercises and a return to full activity.

If your injury was severe or required surgery, it may be closer to the 16 weeks mark before you can return to full activity and be cleared to lift heavier weights.  I recommend that you slowly taper back into your prior activities.  If you are experiencing pain, then back off that particular activity and try it again at a later date.

Help from a Physical Therapist (PT)

Every injury is different. If you’re experiencing pain or difficulty regaining your strength and shoulder range of motion, please consult with a physical therapist that is an orthopaedic certified specialist (OCS). The American Physical Therapy Association (APTA) 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 doctor’s referral (although it may be a good idea to hear your physician’s opinion as well).

Good luck, Shawn! I hope you find this information to be helpful and provide some relief from the pain you’re experiencing.

Have you broken your collarbone? What was your experience like?  Please share your best tips for recovery.

If you have a question that you would like featured in an upcoming blog post, please email contact@thephysicaltherapyadvisor.com. For additional health and lifestyle information, join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice. No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.

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How to Self-Treat Runner’s Knee

MTA_RunnersKnee

http://marathontrainingacademy.com/how-to-self-treat-runners-knee

Marathon Training Academy

August 16, 2015

In this guest post for Marathon Training Academy, you will discover the common symptoms and causes for Patellar Femoral Pain Syndrome (PFPS), also known as runner’s knee, and learn how to effectively self-treat and manage this condition.

LacrosseBallForQuadPatellar Femoral Pain Syndrome (PFPS), also known as runner’s knee, is a common running related issue. The sooner you can manage this condition, the easier it will be to recover and eliminate future problems. As part of a quick and thorough method of treatment, first address the biomechanical causes for the pain. Then utilize the following strategies to quickly recover from the pain in order to keep training and running at a high level.  Continue Reading

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10 Tips to Self-Treat Overtraining Syndrome

Overtraining Syndrome (OTS) can affect any athlete in any sport or at any level. I have treated high school athletes to weekend warriors for OTS. Recently I have noticed more cases of OTS among CrossFit enthusiasts and runners of all distances. People are training harder and longer than ever before with wonderful results. At times, even the best of intentions can lead to not so desirable consequences. OTS usually starts with muscle soreness and a feeling of fatigue. Then it quickly progresses into a case of overtraining syndrome or injury. Overtraining can occur when the intensity and/or volume of exercise becomes too much for the body to properly recover from. For my tips and strategies to prevent OTS, please refer to 12 Tips to Prevent Overtraining Syndrome. In this follow up post, I will specifically address how to self-treat OTS.

Overtraining Syndrome will significantly impede your performance and frequently leads to a serious injury.  In OTS, your body isn’t able to adequately handle or adapt to the high volume and intensity of exercise that you are performing. If you develop OTS, you will need to take specific steps to speed up your recovery in order to prevent injury.  Depending on the duration of symptoms and the severity of the case, OTS is a serious condition which can take a long time to recover from.  OTS not only affects the muscular system, but also the circulatory system, the nervous system, and the hormone regulation system.  Recognizing the warning signs early and being proactive in prevention will help you to avoid OTS.  If you’re already suffering, use the following tips and strategies in your recovery.

ActiveRest

10 Tips to Self-Treat Overtraining Syndrome:

  1. Rest. One of the first and primary treatments for OTS is to rest. More rest is required the longer the overtraining has occurred. Therefore, early detection is critical. If the overtraining has only occurred for a short period of time (such as three to four weeks), then a brief three to five days of rest may be sufficient while implementing the following treatment strategies. After the rest days, slowly taper back into training at a lower training volume until recovery is complete. Typically, the intensity of training can be maintained as long as the volume is decreased. I also advise that you start an alternate day recovery cycle. Train for one day, and then take a day off. This will typically last for a few more weeks before resuming your normal training cycle. As you resume full training, it is important that the warning signs of overtraining are identified and corrected. In more severe cases, the training program may have to be interrupted for weeks or months for a full recovery.
  2. Cross train. Opt for an alternate form of exercise to help prevent exercise withdrawal syndrome. If you are heavily participating in CrossFit or running, choose leisurely cycling and yoga as part of your cross training routine. The key is to keep both training volume and intensity low while preserving a baseline of fitness. Most of the medical studies on overtraining are geared toward single sport athletes. For triathletes and other multi-sport athletes, the recovery process may be different depending on the circumstances. If you can identify that the overtraining has occurred in only one discipline, then resting from that discipline (as well as significantly decreasing training in the other sports) may result in a full recovery. Don’t try to substitute more workouts in one sport in order to compensate for rest in another. This will only worsen the symptoms of OTS, which affects both the parasympathetic (PSN) and sympathetic nervous system (SNS). Resting from overtraining on the bicycle by swimming more will help to rest fatigued quadriceps. However, stress is stress to the cardiovascular, nervous, and hormone systems. Cross training is an important component in your recovery. Incorporate it in your typical training cycles as a method to limit your risk of injury. Cross training can make training more enjoyable as it keeps your body stimulated and ready for improvement. As you recover from OTS, the volume and intensity must be significantly reduced to allow for adequate rest and recovery.
  3. Spot train your weak areas. In addition to cross training, use this recovery time to spot train your weak areas. Work on your mobility and balance as a prevention technique for areas that are prone to injury. If you have a history of low back pain or a prior knee injury, utilize this time to single out all those weak areas in an effort to prevent injury in the future. As you rest from your primary training routine while incorporating cross training, perform spot training as well. The Resource Guide includes a specific exercise section with rehabilitation exercises ranging from low back pain to knee pain. These .pdf files include photos and detailed descriptions to help you get started on spot training your weak areas. This is also an excellent time to work on the specific technical skills that your sport requires. It may include learning how to mentally manage your sport better.
  4. Actively manage your aches and pains. Consider seeing a masseuse for regular body work. Another option is to use the foam roller after exercise to speed up recovery times and decrease the risk of muscle soreness or restriction. To learn how to use a foam roller for self-treatment, please refer to Foam Rolling for Rehabilitation.
  5. Acupuncture. Incorporating acupuncture into your recovery process can be very beneficial. Acupuncture can help to address a multitude of conditions which affect the nervous, muscular, and hormonal systems. All three systems should be addressed during the recovery process. Along with many of my clients, I have experienced wonderful results with acupuncture. I highly recommend an acupuncturist who specializes in sports medicine and has experience treating athletes. During acupuncture sessions, you can take time to specifically work on intentional relaxation and meditation which has the added benefit of addressing the nervous and hormonal systems.
  6. Seek help early. If you are experiencing chronic aches or pain or are struggling with an aspect of your training, seek help immediately. A healthy lifestyle is a lifelong pursuit. If you are injured or not enjoying an activity, you will not stay engaged or motivated in the long term. Seeking advice specifically from an experienced coach, physical therapist, or physician can be beneficial.
  7. Decrease the stimulants. It is important to take steps to help both the nervous and hormonal system re-regulate and rejuvenate. Often with OTS, the adrenals become overtaxed and the level of cortisol (a stress hormone) is too high. Intake of stimulants, such as caffeine, tends to worsen the condition. Remember, caffeine can be found in many pre-work out supplements, running gels, soda, coffee, and tea as well as some over the counter (OTC) medications. During your recovery phase, limiting chemicals that promote stimulation to the nervous and hormonal systems (particularly in regard to cortisol and adrenal function) will speed up your recovery. Once you have recovered and are tapering back into full training, I caution you in limiting stimulants as a prevention strategy for future episodes of OTS.
  8. Eat healthy. A healthy diet is critical to avoid injury. Your body tissue needs nutrients to be able to perform at a high level. Avoid processed food as much as possible. Limit sugary food and add more protein and healthy fat in your diet. Maintaining a diet with adequate healthy fats is essential in providing the nutrients to support all hormone function in the body as well as support the brain and nervous system. In the case of OTS, I encourage that you consume a higher fat diet to help your body’s hormonal system re-regulate. Also, adequate protein intake is necessary to support muscle health and development. For more information on protein intake, please refer to How Much Protein Do I Really Need?
  9. Hydrate more frequently. The human body is primarily made of water, which is critical for all body functions. In the case of OTS, I highly encourage you to hydrate more frequently during recovery. Adequate water intake is critical to avoid dehydration which can negatively affect your training. Dehydrated tissues are prone to injury as they struggle to gain needed nutrients to heal and repair. Dehydrated tissues are less flexible and tend to accumulate waste products. Stay hydrated by drinking water. Try to avoid beverages that contain artificial sweeteners or chemicals with names you can’t spell or pronounce. Coconut water is a popular drink that offers vital nutrients. Also, consider a juicing cleanse with a heavy focus on the kidneys and liver to help detoxify the body.
  10. Supplement. My most recommended supplement to help recover from injury is CapraFlex by Mt. Capra. Essentially, it combines an organic glucosamine and chondroitin supplement with other natural herbs which are designed to reduce inflammation. CapraFlex can be taken long term or intermittently. In the case of OTS, I also recommend a colostrum supplement called CapraColostrum by Mt. Capra. Colostrum is the first milk produced by female mammals after giving birth. It contains a host of immunoglobulins, anti-microbial peptides, and other growth factors. It is especially good at strengthening the intestinal lining which prevents and heals conditions associated with a leaky gut. Colostrum can also help a person more effectively exercise in hotter conditions. Over all, it can boost the immune system, assist with intestinal issues, and help the body to recover faster. Like CapraFlex, Tissue Rejuvenator by Hammer Nutrition contains glucosamine and chondroitin as well as a host of herbs, spices, and enzymes to help support tissues and limit inflammation. I recommend taking either CapraFlex OR Tissue Rejuvenator. You can take CapraColostrum independently or in conjunction with either CapraFlex or Tissue Rejuvenator. I recommend taking these supplements as a recovery strategy. I recommend initially trying a 30 day protocol. If the supplements are aiding your recovery, you may choose to continue taking them for an additional 30 days. I implement this protocol as part of a prevention strategy during times of heavy volume or high intensity training. (Please consult with your pharmacist and/or physician prior to starting any new supplementation protocol. Herbs could interact with some medications particularly if you are taking blood thinners.)

Overtraining Syndrome can be dangerous and severely limit your ability to train.  It also significantly increases your risk of injury.  A recovery protocol should include a multifaceted approach that incorporates strategies to positively affect the muscular, nervous, and hormonal systems.

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.

AVAILABLE NOW ON AMAZON!

In my book, 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.

Discover how you can continue to train hard and avoid the associated poor performance, illness, and injury that can result in lost training days and opportunity!

BUY NOW

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12 Tips to Prevent Overtraining Syndrome

If you exercise or participate in any sport, then you have likely had some experience with Overtraining Syndrome (OTS). It usually starts with extra muscle soreness and a feeling of fatigue. These symptoms can quickly morph into a serious case of overtraining syndrome. Overtraining can occur when the intensity and/or volume of exercise becomes too much for the body to properly recover from.

Although not well understood yet, research indicates two forms of OTS. One affects the sympathetic nervous system (SNS). The other primarily affects the parasympathetic nervous (PNS). Sympathetic OTS tends to affect sprint or power athletes. The resting heart rate tends to be elevated in the sympathetic form. Parasympathetic OTS tends to affect endurance athletes. In the parasympathetic form, the heart rate is even more decreased than typically found in endurance athletes.

TamarackRaceStart

There is no specific test for OTS. The diagnosis is usually determined when a number of factors or symptoms begin to manifest. Warning signs, ranging from mild to severe, include:

  • Fatigue (mild to severe)
  • Muscle and body achiness and soreness
  • A sudden drop in performance
  • A drop in strength
  • A drop in cardiovascular endurance
  • Insomnia or excessive sleepiness
  • Headache
  • Illness due to a drop in your immune function
  • Irritability and moodiness
  • Decreased appetite or weight loss
  • An increase in your resting heart rate
  • A decrease in your heart rate variability
  • A substantial drop in training capacity and/or intensity
  • Depression and a loss of enthusiasm for activities (such as training)

Avoid Overtraining Syndrome if you want to effectively train at a high level.  It not only impedes your immediate performance, but it also substantially increases your risk of injury.  Remember, recovery from a workout is a critical part in avoiding OTS.  Your recovery routine should be an intentional and a multifaceted approach.

12 Tips to Prevent Overtraining Syndrome:

  1. Keep a training diary. An exercise or training diary allows you to keep track of how you feel before, during, and after workouts. How did your body respond to training that day? How did you sleep? How was your food intake and nutrition? Also, record your heart rate response during your exercise session. Document as many variables as you can in order to look for patterns. Discover which combinations work well for you and those that have a negative effect on training. Focus on the positive and eliminate variables which cause negative effects. The diary helps you to keep track of it all. There are software programs available to assist in this as well. One such program popular with cyclists and triathletes is Training Peaks.
  2. Monitor heart rate variability. Another potential warning factor for overtraining syndrome is heart rate variability (HRV). It is simply the variation in the time interval between heartbeats. HRV is affected by stress, hormone changes, and changes in the sympathetic or parasympathetic system. A decrease in parasympathetic activity or increased sympathetic activity will result in reduced HRV. A reduced HRV is a sign of OTS. The higher the HRV, the more capable your nervous system is able to adapt to stress. Many different apps can quickly measure HRV. Some apps are more accurate than others. The more accurate and precise the measurement, the more expensive the app. One free app that I use and recommend is Azumio’s Instant Heart Rate.
  3. Monitor for OTS warning signs. Watch for the warning signs (listed above) and decrease your training volume if you are experiencing symptoms. Listen to your body.
  4. Cool down. After performing your exercises, take the extra time to cool down and stretch. Choose exercises and activities that provide range of motion (ROM) to the particular area that you just trained or used. The perfect time to perform static stretching is after exercising. Work on tight and restricted areas. Keep moving throughout the day and avoid sitting for extended periods of time.
  5. Foam rolling. The foam roller is a wonderful tool which allows you to manipulate the body’s soft tissues. This has a potential positive effect on the fascial system, the musculotendinous system, and the circulatory system. It can aid in recovery by improving blood flow and reducing myofascial restrictions. To learn how to use a foam roller for self-treatment, please refer to Foam Rolling for Rehabilitation.
  6. Active recovery. Every day shouldn’t be an intense training day. As part of your training cycles, be sure to include time to participate in other activities to help the body to recover and rejuvenate. Participate in a yoga class, take a leisurely bike ride, or take a walk in the park.
  7. Proper periodization. You cannot and should not train at a super high intensity all year long. Your work volume needs to be properly periodized. Well-balanced gradual increases in training are recommended. Be sure your training plan varies the training load in cycles with built in mandatory rest phases throughout the year. The plan will likely be based on when you need to peak for certain events or races. During the high workload phase, try to alternate between high intensity interval work and low intensity endurance work.
  8. Taper up the training volume appropriately. The 10 Percent Rule is a guideline that many fitness experts use to help athletes (of all levels) avoid injury while improving performance. Many cases of OTS can be attributed to increasing the intensity, time or type of activity too quickly. The 10 Percent Rule sets a weekly limit on training increases. The guideline indicates not to increase your activity more than 10 percent per week. That includes distance, intensity, amount of weight lifted, and/or time of exercise. For example, if you are running 30 miles per week and want to increase the distance, add 3 miles during the next week for a total of 33 miles a week. If you are squatting 200 pounds and want to increase, don’t add more than 20 pounds during the next week. The 10 Percent Rule is only a guideline. In some cases, 10 percent may be too much. Instead, a 5 percent increase per week may be much more realistic.
  9. Rest more. Your body must rest in order to grow and develop. Training every day is not the best way to improve. It can lead to injury and burn out. Take a rest day and have fun. Sleep more. Proper programming includes mini cycles with an off season as well as active rest cycles in between heavy load and heavy volume training cycles. Don’t fear rest, embrace it!
  10. Eat healthy. Your body tissue needs nutrients to be able to perform at a high level. Avoid processed food as much as possible. Limit sugary food and add more protein and healthy fat in your diet. Maintaining a diet with adequate healthy fats is essential in providing the nutrients to support all hormone function in the body as well as support the brain and nervous system. Adequate protein intake is necessary to support muscle health and development. For more information on protein intake, please refer to How Much Protein Do I Really Need?
  11. Stay hydrated. The human body is primarily made of water, which is critical for all body functions. Adequate water intake is critical to avoid dehydration which can negatively affect your training. Dehydrated tissues are prone to injury as they struggle to gain needed nutrients to heal and repair. Dehydrated tissues are less flexible and tend to accumulate waste products. Stay hydrated by drinking water. Try to avoid beverages that contain artificial sweeteners or chemicals with names you can’t spell or pronounce.
  12. Supplement. I take certain supplements during times of heavy training volume or when I am in a phase of overreaching. I also take them intermittently to help prevent injury or heal from one. My most recommended supplement is CapraFlex by Mt. Capra. Essentially, it combines an organic glucosamine and chondroitin supplement with other natural herbs which are designed to reduce inflammation. CapraFlex can be taken long term or intermittently to help heal from an injury. I also recommend a colostrum supplement called CapraColostrum by Mt. Capra. Colostrum is the first milk produced by female mammals after giving birth. It contains a host of immunoglobulins, anti-microbial peptides, and other growth factors. It is especially good at strengthening the intestinal lining which prevents and heals conditions associated with a leaky gut. Colostrum can also help a person more effectively exercise in hotter conditions. Over all, it can boost the immune system, assist with intestinal issues, and help the body to recover faster. Both of these supplements can be used in heavy volume or intense training phases to help you to recover faster and avoid OTS.  (If you are taking blood thinners, please consult with your physician prior to use as the herbs could interact with some medications.)

If you begin to experience any of the warning signs of OTS, be proactive about modifying your training.  It is important to objectively measure your training routine and make adjustments before you become sick, overtrained or injured.  Incorporate these recommended prevention strategies to help keep your training at a high level. In the follow up post, 10 Tips to Self-Treat Overtraining Syndrome, I specifically address self-treatment strategies.

If you are experiencing chronic aches or pain or are struggling with an aspect of your training, seek help immediately.  Seeking advice specifically from an experienced coach, physical therapist, or physician can be beneficial.

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.

AVAILABLE NOW ON AMAZON!

In my book, 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.

Discover how you can continue to train hard and avoid the associated poor performance, illness, and injury that can result in lost training days and opportunity!

BUY NOW

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Q & A: How to Self-Treat a Baker’s Cyst

Q.  My knee started hurting about two weeks ago. I have noticed swelling in the back of my knee.  It’s painful when I bend or straighten the knee.  I looked up the symptoms on WebMD.  I think I might have a Baker’s cyst, but I’m not sure what to do now.  Your insight would be appreciated, thanks!  –Patti

A.  Great question, Patti! The symptoms you are describing sound like they may be caused by a Baker’s cyst.  Another common diagnosis with similar symptoms would be a meniscus injury.  I recommend that you read my previous post on meniscus pain, Q & A: 7 Tips to Get Rid of Knee Pain.  Much of the advice will carry over to either condition.

A Baker’s cyst, also known as a popliteal cyst, is a fluid-filled sack that forms in the back of the knee.  Synovial fluid from inside of the knee pushes out into a fluid-filled sack in the back of the knee.  Sizes of the cysts can wildly vary as do the symptoms.  The cyst can typically best be seen when a person is standing.  It may or may not be tender to the touch.  In fact, you may or may not have any symptoms at all.

BakersCyst_Arrows

Baker’s cyst symptoms include:

  • Stiffness or tightness in the back of the knee, thigh, or upper calf.
  • Swelling noted behind the knee. If the cyst ruptures, then the swelling may be also be in the lower leg and calf area.
  • Pain is most typically described behind the knee, particularly with full flexion (bending) or extension (straightening). A person may also experience pain in the upper calf or back of the thigh.
  • Another common complaint is pain when sitting due to the chair touching or rubbing the area behind the knee (known as the popliteal space).

It is not always entirely known why a Baker’s cyst will develop.  In my clinical experience, I have seen them form for the following reasons:

  • Rheumatoid arthritis (RA)
  • Osteoarthritis (OA)
  • Recent knee injury or post knee surgery
  • Poor lower leg biomechanics, which can lead to other forms of knee pain in addition to a Baker’s cyst.

Baker’s cysts should be diagnosed by a medical doctor.  Medical treatment of the cysts usually involves a course of anti-inflammatory medication (orally), a cortisone injection, aspiration of the fluid by utilizing a needle, and/or surgical removal.  The good news is that often a Baker’s cyst will typically resolve on its own if you just give it time.  Rest and treat any symptoms you may be experiencing.

Physical therapy may also be indicated, particularly if the cyst formed due to osteoarthritis pain, recent knee injury/trauma/surgery, or due to poor lower extremity biomechanics.  In most cases, I have witnessed Baker’s cysts successfully and conservatively treated by both a physical therapist and a medical physician who are working together to address the issue.

The rehabilitation for a Baker’s cyst is very similar process to treating meniscus pain.  The following 10 tips will help you to rehabilitate your knee.  You should experience improvement of your symptoms within in a few of weeks or less when initiating this program.  Depending on the severity, it could take longer for a full recovery.  If your pain continues or worsens, then additional assessment and follow up is likely needed.

10 Tips on How to Self-Treat a Baker’s Cyst:

1.  Rest. Initially, take extra time to rest the painful area. The pain and swelling has likely worsened due to a change in activity level.  If the pain is more severe, you may choose to use a cane or a crutch initially to take weight off of the knee.

2.  Ice. Apply ice to the knee and behind the knee in particular. The rule of thumb is to ice no more than 20 minutes per hour.  Do not place the ice directly against the skin especially if you are using a gel pack style Cold Pack.  Individuals with poor circulation or impaired sensation should take particular care when icing.  A bag of frozen peas can be ideal in this situation.

3.  Compression. Compression helps to prevent and decrease swelling. Swelling can cause increased pain and slow the healing response.  Limit it as much as possible.  You could utilize a common ACE bandage wrap or you could purchase a pair of mild over-the-counter compression socks.  If you utilize a compression sock, it will need to be at least thigh high like these Jobst Relief Therapeutic Thigh High Stockings.  Do not use a knee high version–you may make the swelling and pain worse.  Do not apply any compression too tightly as it could cause numbness or tingling in the leg, foot, or toes.

4.  Taping Techniques. Kinesiological style taping has been proven to be effective in reducing inflammation. Due to the location of the swelling, you will need help from someone trained in the specific style of kinesiological taping.  Many physical therapists (PTs), athletic trainers (ATCs), or chiropractors have training in these techniques.  Learn How to apply Kinesiology Tape for a swollen (edema) Knee Joint by watching this YouTube video that demonstrates the proper technique.  (However, the taping would be on the back side of the knee, not on the front as shown.)  I have had luck using the KT TAPE, RockTape Kinesiology Tape, and Mummy Tape brands.  The technique is fairly basic, so your spouse or a friend may be able to apply it for you.

5.  If it hurts, don’t do it! Modify the activity or discontinue it completely. If your knee is hurting when performing a squat, then initially don’t move as deep into the exercise.  This would also be true for a lunge position or step up.  Modify any exercise as you need to, and don’t compromise technique to complete an exercise.  Poor technique will only increase your risk of injury elsewhere or make the knee more painful and irritated.

6.  Warm up prior to exercise. I recommend that you increase your normal warm up time by at least 10 minutes in order to increase blood flow to the area. This allows for better mobility and also promotes healing as movement is necessary to bring in the nutrients.  Use a stationary bike or the rower machine initially to get the muscles warm and the knee joint more lubricated.

7.  Improve your Range of Motion (ROM). The goal of the rehabilitation program is to regain full pain free ROM. This can be accomplished many ways.  Perform heel slides by lying on your back and sliding your heel toward your buttocks.  Riding the stationary bicycle can be helpful, too.  Remember, the major goal is to regain full pain free ROM.  If you experience muscle tightness and soreness, I recommend using a foam roller to assist with any myofascial symptoms.  To learn how to use a foam roller, please refer to Foam Rolling for Rehabilitation. Do not use the foam roller directly behind the knee.

8.  Work on strengthening. The primary goal of a strengthening program is to work on quadriceps and glut medius (hip abduction) strengthening. These areas are commonly weak which can lead to poor knee biomechanics and cause pain and instability.  Weight lifting is an appropriate choice, but you may have to initially limit your range of motion (ROM).  Most of my clients begin on a non-weight bearing program, then progress to partial weight bearing, and eventually, full weight bearing.  The more severe the symptoms, the longer it will take for an individual to progress to more difficult exercises.

To initiate a physical therapy program, please refer to Baker’s Cyst Rehabilitation Exercises.  This exercise guide is designed to address the muscles that I find to be the weakest in most individuals.  The exercises are listed from easiest to most challenging and are designed to primarily improve quadriceps and hip strengthening.  Start with exercises like a straight leg raise (possibly with an ankle weight) and bridging (either one or both legs).  Wall squats holding for time also works well.  A Thera-Band Exercise Band can be tied around the thighs above your knees to make your hips more engaged.

Weight training exercises (with machine weights or free weights) should be geared toward general leg strengthening and may include: squats; leg press; hip abduction machine; step ups; dead lifts; and straight leg dead lifts.  If further instruction is needed, search YouTube to watch the proper technique for a specific exercise.  If full ROM is causing an increase in your pain, then you need to stay within your pain free limit as you work on the ROM separately from weight training.

Initially, you will likely need to taper down your activities.  The speed at which exercise is performed while in group exercise classes is typically too fast for an individual who is properly and safely exercising his/her knee during a rehabilitation and recovery phase.  You can still participate in group exercise classes or CrossFit WODs (Work out of the Day), but your specific knee program should be separate from any group structured activity.  You will need to modify some of the activities performed in your structured class to avoid further pain.

9.  Cool down. After performing your exercises, take extra time to cool down and stretch. Use either a stationary bike (at a causal/slower pace) or the rower machine.  Both are reduced weight bearing exercises that promote movement and circulation to the knee as well as increasing ROM.

10.  Add a joint supplement. If you are experiencing osteoarthritis pain, you may want to consider adding a glucosamine and chondroitin supplement. CapraFlex is my preferred supplement for knee related injuries.  I have recommended this supplement for years as my clients have had successful outcomes with use.  It has also assisted me in recovery from my many injuries.  Essentially, it combines an organic glucosamine and chondroitin supplement with other natural herbs which are designed to reduce inflammation.  CapraFlex can be taken long term or intermittently to help heal from an injury.  I recommend that you try it for 30 days to see if it improves your knee pain, but do not use it in combination with other traditional anti-inflammatory medications.  If you are under the care of your physician, please inform him/her that you are taking this medication.  (If you are taking blood thinners, please consult with your physician prior to use as the herbs could interact with some medications.)

In most cases, you should expect a complete resolution of your symptoms upon completion of the rehabilitation process. To prevent the condition from re-occurring, address any ROM or mobility restrictions as well as any weak areas that are causing altered lower leg biomechanics.

If your symptoms and pain continues or worsens after two to three weeks of rehabilitation, please seek additional assistance from your physician or a qualified physical therapist.  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 doctor’s referral (although it would be a good idea to seek your physician’s opinion as well).

Thank you, Patti, for your question.  I hope these 10 tips will help you to rehabilitate your knee and recover quickly!

Which treatments for knee pain are the most effective for you?  Please share any recommendations that you may have by leaving your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice.  No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.

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How to Self-Treat Patellar Femoral Pain Syndrome (Runner’s Knee)

Patellar Femoral Pain Syndrome (PFPS), also known as runner’s knee, is a common running related issue.  The sooner you can manage this condition, the easier it will be to recover and eliminate future problems.  Many of my recommended exercises can be adopted as part of a cross training program to prevent PFPS.  I will address the many potential causative factors for PFPS and offer advice on how to self-treat this condition.

PFPS can be quite painful and significantly affect a person’s ability to run or move properly.  The cause of the pain is often associated with a patellar or knee cap that is tracking in the femoral groove improperly.  This can occur for many reasons, but the most common causes are:

  1. Poor quadriceps strength (particularly the inner or medial quadriceps).
  2. Poor hip abductor and/or hip external rotator strength.
  3. Improper foot biomechanics during the single leg stance phase of the gait cycle or the mid foot strike during running. The most common issue within the foot is usually overpronation (when the feet excessively roll inward and cause the knee to roll inward as well during each step). Overpronation is more common among females although males experience it as well. Women may experience overpronation due to the angle of their hips in relation to the knee. A woman’s pelvis is typically a different shape to allow for child bearing. The larger “Q-angle” associated with the hip and knee can cause increased strain on the knee.

PFPS symptoms include:

  • The pain will typically increase when going downstairs. In more severe cases, going upstairs is also very painful.
  • Pain with squats, lunges, knee extensions, or other plyometric activity.
  • Pain typically worsens with prolonged sitting. The longer you sit in one position, the worse the pain becomes.
  • Grinding, popping, and cracking are often associated symptoms.
  • Pain can be anywhere along the patella (knee cap), but it’s typically associated with anterior knee pain or medial patellar pain.

In many cases, a very thorough warm up may allow you to participate in activity.  However, the pain may worsen again later that day or the next day.  Seek help or guidance quickly when your pain worsens with activity.  For the best result, the treatment plan should be multifactorial.

How to Self-Treat PFPS:

  • Improve your quad and your hip strength. Please refer to Patellar Femoral Pain Syndrome Rehabilitation Exercises for my recommended exercise program which is designed to improve quad and hip strength. To improve your quad strength, the emphasis should be on the inner quad known as the vastus medialis oblique (VMO). Weak hip abduction and hip external (lateral) rotation muscles significantly contribute to PFPS. The purpose of the lateral and external rotators of the hip is to prevent internal rotation (rolling inward) of the hip and knee. My recommended exercise program will help to improve your strength.
  • Warm up prior to exercise. I recommend that you increase your normal warm up time by at least 10 minutes in order to increase blood flow to the area. This allows for better mobility and also promotes healing as movement is necessary to bring in the nutrients. Use a stationary bike or the rower machine initially to get the muscles warm and the knee joint more lubricated. Then work on moving into a deep squat position multiple times as part of the warm up. You may need to hang onto a beam or a pole to take some pressure off of your knee as you move in and out of the squat.
  • Cool down. After performing your exercises, take extra time to cool down and stretch. Use either a stationary bike (at a causal/slower pace) or the rower machine. Both are reduced weight bearing exercises that promote movement and circulation to the knee as well as increasing range of motion (ROM).
  • Self-Mobilize the Tissue. Myofascial release of the quadriceps muscle is an important component in order to relieve the pain and reduce the pressure and tension through the patellar femoral tendon and joint. I tend to use the foam roller for the larger part of the quadriceps. I also use a tennis or lacrosse ball to aggressively work the tissue above the patella. You can use your hand to press the ball in and work it around the tissue. To use the weight of your leg for a more aggressive mobilization, place the ball on the ground and mobilize the tissue with your leg on top of the ball.

LacrosseBallForQuad

  • Kinesiological Taping. The purpose of the tape is to assist the patella in its tracking. I have had luck using Kinesio Tape and Mummy Tape brands. There are many other useful taping techniques which utilize different forms of tape. When treating PFPS, I recommend that you apply the tape in a medial direction across the patella approximately 30 minutes prior to exercise or activity. To utilize Mummy Tape, first measure how much of the tape you intend to use. Start from the outside of the knee cap to half way around the leg minus about an inch. Cut the strip, then round the corners on the edge of the tape. This helps the tape to not catch onto clothing. Apply the tape without extra stretch to the first half of the knee cap, then apply between a 50-75% stretch for half of the tape medially toward the inside of the leg. With the last of the tape, apply without a stretch to the inner side of the leg. (You could also utilize Spider tape or KT TAPE.) To visually learn how to apply the tape, please refer to Kinesiological Taping for Patellar Femoral Pain Syndrome. For application and removal tips, please refer to Skin Care with Taping.
  • If it hurts, don’t do it! Modify the activity or discontinue it completely. If your knee is hurting when performing a squat, then initially don’t move as deep into the exercise. This would also be true for a lunge position or step up. Modify any exercise as you need to, and don’t compromise technique to complete an exercise. Poor technique will only increase your risk of injury elsewhere.
  • Have your gait analyzed while running. Check with your local running store or a physical therapy clinic for a monthly gait analysis clinic. If you’re not a runner, but you’re experiencing pain during other forms of exercise (group aerobics or CrossFit), ask your teacher or coach to analyze your movements during an exercise session. How is your foot striking the ground? Is it rolling in (landing flat footed)? Does your knee rotate inward or stay tracking in line with the foot? Ideally, the knee tracks in line with your second toe. This is important for running as well as squats, step ups, and lunges. If your foot isn’t maintaining a good position during its mid foot strike, a new pair of shoes may be indicated specifically to control pronation. Over-the-counter orthotics can help as well. Superfeet Blue Premium Insoles are available in varying models to help support the arch and heel. They are color coded by model. I wear the blue insoles which are for moderately flat feet. These insoles are very durable. In the past, these insoles have lasted for 1,000 miles through the life cycles of two different pairs of shoes.
  • Start a supplement. Many herbs help to reduce inflammation and pain. CapraFlex is one of my favorite supplements. Essentially, it combines an organic glucosamine and chondroitin supplement with other natural herbs which are designed to reduce inflammation. CapraFlex can be taken long term or intermittently to help heal from an injury. I recommend that you try it for 30 days to see if it improves your pain. Another option is Phenocane Natural Pain Management. It combines the following: Curcumin, an herb that reduces pain and inflammation; boswellia, a natural COX2 inhibitor that also reduces pain and inflammation; DLPA, an amino acid that helps to increase and uphold serotonin levels in the brain; and nattokinase, an enzyme that assists with blood clotting and reduces pain and inflammation. (If you are taking blood thinners, please consult with your physician prior to use as the herbs could interact with some medications.)

Patellar Femoral Pain Syndrome can be very painful, but it can be easily self-treated if you handle your pain and symptoms quickly.  If you’re not experiencing relief after aggressively managing the symptoms, contact your local physical therapist for an assessment and help in managing PFPS.  The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area.

Has a specific treatment for PFPS helped you? Which treatments haven’t worked for you? Additional discussion can help others to manage this condition more effectively.  Please leave your comments below.

Don’t forget 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!

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

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Top 10 Strategies to Avoid Injury

An ounce of prevention is worth a pound of cure.  –Benjamin Franklin

As a physical therapist, I help people who have suffered from an injury through the process of rehabilitation.  Accidents will happen, but certain activities can help you to avoid and limit the chance of an injury.  Nothing will derail a perfectly designed training program like an injury.  Optimize your health and lessen your risk of injury by being proactive upfront.

Top 10 Strategies to Avoid Injury:

1.  Warm up prior to exercise. I recommend that you increase your normal warm up time by at least 10 minutes in order to increase blood flow to the area.  This allows for better mobility and also promotes healing as movement is necessary to bring in the nutrients and remove any cellular waste products.  I like to use a stationary bike or the rower machine initially to get the muscles warm and the knee joint more lubricated.

2.  Cool down. After performing your exercises, take extra time to cool down and stretch.  Use either a stationary bike (at a causal/slower pace) or the rower machine.  Both are reduced weight bearing exercises that promote movement and circulation to the knee as well as provide range of motion (ROM).  The perfect time to perform static stretching is after exercising.  Work on those tight and restricted areas.  Keep moving throughout the day and avoid sitting for extended periods of time.

CoolDownStretch

3.  Eat healthy. A healthy diet is critical to avoid injury.  Your body tissue needs nutrients to be able to perform at a high level.  Avoid processed food as much as possible.  Limit sugary food and add more protein and healthy fat in your diet.  Maintaining a diet with adequate healthy fats is essential in providing the nutrients to support all hormone function in the body as well as support the brain and nervous system.  Adequate protein intake is necessary to support muscle health and development.

4.  Stay hydrated. The human body is primarily made of water, which is critical for all body functions.  Adequate water intake is critical to avoid dehydration which can negatively affect your training.  Dehydrated tissues are prone to injury as they struggle to gain needed nutrients to heal and repair.  Dehydrated tissues are less flexible and tend to accumulate waste products.  Stay hydrated by drinking water.  Try to avoid beverages that contain artificial sweeteners or chemicals with names you can’t spell or pronounce.

5.  Supplement. I take certain supplements during times of heavy training volume or when I am in a phase of overreaching.  I also take them intermittently to help prevent injury or heal from one.

My most recommended supplement is CapraFlex by Mt. Capra.  Essentially, it combines an organic glucosamine and chondroitin supplement with other natural herbs which are designed to reduce inflammation.  CapraFlex can be taken long term or intermittently to help heal from an injury.

I also recommend a colostrum supplement called CapraColostrum by Mt. Capra.  Colostrum is the first milk produced by female mammals after giving birth.  It contains a host of immunoglobulins, anti-microbial peptides, and other growth factors.  It is especially good at strengthening the intestinal lining which prevents and heals conditions associated with a leaky gut.  Colostrum can also help a person more effectively exercise in hotter conditions.  Over all, it can boost the immune system, assist with intestinal issues, and help the body to recover faster.

Like CapraFlex, Tissue Rejuvenator by Hammer Nutrition contains glucosamine and chondroitin as well as a host of herbs, spices, and enzymes to help support tissues and limit inflammation.  I recommend taking either CapraFlex OR Tissue Rejuvenator.  You can take CapraColostrum independently or in conjunction with either CapraFlex or Tissue Rejuvenator.

I recommend taking these supplements for injury prevention or as a recovery strategy.  I recommend trying a 14-30 day protocol.  (Please consult with your pharmacist and/or physician prior to starting any new supplementation protocol.)

6.  Take cross training seriously. Performing the same activity day after day without variation can lead to overuse injuries or muscle imbalances.  You may spend a majority of your time specifically training for a particular sport or activity, but it is important to vary the training load and/or stimulus.  Not only can cross training limit your risk of injury, it makes training fun by keeping the body stimulated and ready to improve.

7.  Actively manage your aches and pains. Spot train your weak areas and work on whole body mobility and fitness.  Don’t neglect the small stuff as it will catch up with you sooner or later.  Consider seeing a masseuse for regular body work.  To learn how to use a foam roller for self-treatment, please refer to Foam Rolling for Rehabilitation.

8.  If it hurts, don’t do it! Modify the activity or discontinue it completely. Modify any exercise as you need to, and don’t compromise technique to complete an exercise.  Poor technique will only increase your risk of injury elsewhere.  Work with your coach or athletic trainer to determine if poor form and technique is causing the pain.  With instruction, you may avoid pain and injury while taking your training to the next level.

9.  Adequate rest is important. Your body must rest in order to grow and develop.  Training every day is not the best way to improve.  It can lead to injury and burn out.  Take a rest day and have fun.  Participate in a yoga class, take a leisurely bike ride, or take a walk in the park.   If you are participating in a yearly training cycle, be sure to incorporate an off season which involves a change of pace from your regular training and some active rest.  Proper programming includes mini cycles with an off season as well as active rest cycles in between heavy load and heavy volume training cycles.

10.  Seek help early. If you are experiencing chronic aches or pain or are struggling with an aspect of your training, seek help immediately.  A healthy lifestyle is a lifelong pursuit.  If you are injured or not enjoying an activity, you will not stay engaged or motivated in the long term.  Seeking advice specifically from a running coach, physical therapist, or physician can be beneficial.

Unfortunately, injuries will occur.  However, incorporating these strategies will reduce your risk of injury while likely taking your training and exercise program to the next level.  If and when an injury occurs, take it seriously and manage it quickly.

How do you avoid injury?  Which particular strategy has aided in your recovery?  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice.  No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.

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Q & A: 7 Tips to Get Rid of Knee Pain

Q.  Over the last month or so, I have had a pain in the back of my knee. My knee feels really stiff when I sit cross-legged or try to squat.  What should I do? –Sam

A.  Great question, Sam! The symptoms you are describing sound like the pain may be coming from your meniscus.  The meniscus is the cushion found between the two major leg bones, the femur and the tibia.  It is made of a cartilaginous substance.  Many times, the meniscal cartilage can be torn.  It would be similar to getting a hang nail near your cuticle.  A tear occurs when the cartilage rises up and causes pain, a feeling of knee instability, and/or locking up of the knee.  Other times, the cartilage can become frayed like an old rope.  This fraying can cause pain and stiffness, particularly pain behind the knee in an area known as the popliteal space.

The good news is that most meniscal related injuries don’t require surgery. Research suggests that the proper physical therapy program can be superior to surgical intervention with long term outcomes. There are times when surgery will be indicated, but physical therapy is typically indicated as an initial course of action.  (Particularly, when there are no episodes of knee locking occurring.)

Wall Squat

The following 7 tips will help you to rehabilitate your knee.  If symptoms worsen, then additional assessment and follow up is likely needed.  I would anticipate an improvement of your symptoms in a few of weeks or less when initiating this program.  (Depending on the severity, it could take longer for a full recovery.)  If the pain continues, please seek additional assistance from a qualified physical therapist or physician.

1.  Warm up prior to exercise.  I recommend that you increase your normal warm up time by at least 10 minutes in order to increase blood flow to the area. This allows for better mobility and also promotes healing as movement is necessary to bring in the nutrients.  Use a stationary bike or the rower machine initially to get the muscles warm and the knee joint more lubricated.  Then work on moving into a deep squat position multiple times as part of the warm up.  You may need to hang onto a beam or a pole to take some pressure off of your knee as you move in and out of the squat.

Deep Squat Position

2.  If it hurts, don’t do it!  Modify the activity or discontinue it completely.  If your knee is hurting when performing a squat, then initially don’t move as deep into the exercise.  This would also be true for a lunge position or step up.  Modify any exercise as you need to, and don’t compromise technique to complete an exercise.  Poor technique will only increase your risk of injury elsewhere.

3.  Work on strengthening.  The primary goal of a strengthening program is to work on quadriceps and glut medius (hip abduction) strengthening.  Weight lifting is an appropriate choice, but you may have to initially limit your range of motion (ROM).  Most of my clients begin on a non-weight bearing program, then progress to partial weight bearing, and eventually, full weight bearing.  The more severe the symptoms, the longer it will take for an individual to progress to more difficult exercises.

To initiate a physical therapy program, please refer to Meniscus Rehab Exercises.  This exercise guide is designed to address the muscles that I find are weakest in most individuals.  The exercises are listed from easiest to most challenging and are designed to primarily improve quadriceps and hip strengthening.  Start with exercises like a straight leg raise (possibly with an ankle weight) and bridging (either one or both legs).  Wall squats holding for time also works well.  A Thera-Band Exercise Band can be tied around the thighs above your knees to make your hips more engaged.

Weight training exercises (with machine weights or free weights) should be geared toward general leg strengthening and may include: squats; leg press; hip abduction machine; step ups; dead lifts; and straight leg dead lifts. If further instruction is needed, search YouTube to watch the proper technique for a specific exercise.

The speed at which exercise is performed while in group exercise classes is typically too fast for an individual who is properly and safely exercising his/her knee during a rehab and recovery phase.  You can still participate in group exercise classes or CrossFit WODs (Work out of the Day), but your specific knee program should be separate from any group structured activity.  You need time to insure proper technique.

4.  Cool down. After performing your exercises, take extra time to cool down and stretch. Use either a stationary bike (at a causal/slower pace) or the rower machine.  Both are reduced weight bearing exercises that promote movement and circulation to the knee as well as increasing range of motion (ROM).

5.  Improve your Range of Motion (ROM).  The goal of the rehabilitation program is to regain full pain free ROM.  This can be accomplished many ways.  Perform heel slides by lying on your back and sliding your heel toward your buttocks.  Consider using a pole to assist in performing deeps squats.  Hang onto a pole or a door frame, and bring your heel toward your buttocks as you perform a quadriceps stretch.  These exercises can be performed within a mild to moderate amount of discomfort in order to regain full pain free ROM.  If you experience muscle tightness and soreness, I recommend using a foam roller to assist with any myofascial symptoms.  To learn how to use a foam roller, please refer to Foam Rolling for Rehabilitation.

6.  Drink more water.  Cartilage tends to have a poor blood supply.  The more water you drink, the more hydrated your body becomes.  This can help the body to deliver much needed hydration and nutrients to the meniscus.

7.  Add a joint supplement. CapraFlex is my preferred supplement for meniscal related injuries. I have recommended this supplement for years as my clients have had successful outcomes with use.  I have taken it to help prevent injury as I entered a particularly intense period of training as I prepared for a marathon.  It has also assisted in recovery from my many injuries.  Essentially, it combines an organic glucosamine and chondroitin supplement with other natural herbs which are designed to reduce inflammation.  CapraFlex can be taken long term or intermittently to help heal from an injury.  I recommend that you try it for 30 days to see if it improves your knee pain.  (If you are taking blood thinners, please consult with your physician prior to use as the herbs could interact with some medications.)

Thank you, Sam, for your question. I hope these 7 tips will help you to rehabilitate your knee and recover quickly!  If the pain continues, please seek additional assistance from a qualified physical therapist or physician.

Which treatments for knee pain are the most effective for you? Please share any recommendations that you may have by leaving your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice. No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.

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How to Safely Self-Treat Low Back Pain

Did you know that an estimated $50 billion dollars is spent annually on back pain related issues?   Low back pain (LBP) is 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.  The previous post, 12 Sure Fire Ways to Injure Your Back, addressed potential risk factors for low back pain. This follow-up post includes how to safely self-treat your low back pain and helpful methods for a speedy recovery. (Not to mention, possibly saving you time and money by avoiding a physician visit for minor pain!)

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.

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.  For a thorough discussion and an excellent treatment resource, please refer to Treat Your Own Back by Robin A. McKenzie.

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.

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.

PressUps

  • 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.

StandingBackExtensions

  • 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. The 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. Make sure you stand with good posture as well.
  • Stretch the Muscles of the Legs and Pelvis – Hamstring, Hip Flexor, and Piriformis Stretches for LBP 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.
  • Reduce Inflammation and Support the Healing Response – I recommend starting a thirty day course of CapraFlex by Mt. Capra.  CapraFlex is an organic glucosamine and chondroitin supplement which also includes an herbal and spice formulation designed to naturally decrease inflammation and support healing.  I recommend it to anyone recovering from an injury or attempting to prevent injury when performing at a very high level. I personally use it, and in my practice, it has helped clients recover faster and prevent injury. It can interfere with some blood thinning medication, so if you are on this type of medication, please check with your physician.
  • Ice as Needed for Pain – The rule for icing is to apply ice no more than twenty minutes per hour. Do not place the ice directly against the skin, especially if you are using a gel pack style. Individuals with poor circulation or impaired sensation should take particular care when icing.
  • Use Topical Analgesics for Pain – There are many topical agents which can be used for pain. My two favorites to help manage pain and stiffness are Arnica Montana (an herbal rub) and Biofreeze.
  • Be as Active as You Can – Don’t stop moving! It’s important that you remain as active as you can. You should taper 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. 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.
  • Ask for Help – Yes, even physical therapists have to ask for help sometimes! Many useful manual techniques can help to manage LBP. You just can’t perform them on yourself. If your pain is not improving, I highly suggest seeking a qualified and competent physical therapist who works with clients suffering from LBP. 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 doctor’s referral (although it may be a good idea to seek your physician’s opinion as well).

Low back pain is a serious and debilitating condition. It will either most certainly affect you or someone close to you.  Be pro-active in maintaining a healthy back by incorporating these helpful methods for a speedy recovery.  Don’t let LBP affect your ability to stay active and keep enjoying your favorite activities!

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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!

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